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Proximal collaterals may determine the composition of occluding thrombi in acute ischemic stroke ( AIS ) in addition to source, hematocrit, time, and medication. Here, we performed a retrospective study of 39 consecutive patients with radiological evidence of I‐, L‐, and T‐type terminal internal carotid artery occlusion. Middle cerebral artery ( MCA ) thrombus density was assessed on noncontrast enhanced  CT  and proximal collaterals on  CT  angiography. In patients with presence of proximal collaterals to the  MCA  we detected more hyperdense clots ( P  = 0.003) and a higher frequency of leptomeningeal collaterals ( P  = 0.008). We expand the spectrum of factors that potentially determine clot perviousness and evolution of ischemic stroke.

Proximal flow to middle cerebral artery is associated with higher thrombus density in terminal internal carotid artery occlusion