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LOT-910 exam Dumps Source : IBM WebSphere Portal 7.0 Deployment and(R) Administration Update

Test Code : LOT-910
Test denomination : IBM WebSphere Portal 7.0 Deployment and(R) Administration Update
Vendor denomination : IBM
: 44 actual Questions

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IBM IBM WebSphere Portal 7.0

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IBM Buffs workplace and WebSphere Portal
  • via Stuart J. Johnston
  • November eleven, 2004
  • IBM this week introduced modern and up-to-date products in its office family unit of collaboration items, together with 19 position-based built-in functions for medium and little company shoppers. The enterprise additionally talked about it's going to give advert hoc web conferencing as a carrier for clients starting in December.

    The options supply customizable traffic services for particular industries or categories of company projects and operations – totality constructed the usage of IBM office items and chosen third-birthday party functions.

    although perhaps a cliché through now, IBM officials additionally continued to emphasise the ameliorations between a “community-delivered” collaboration ambiance and one based mostly essentially on personal computer systems – certainly Microsoft’s view. “[With Workplace Solutions] you should not believe to believe Microsoft office,” says Larry Bowden, vice president, of IBM workplace utility solutions.

    IBM designed the solutions by means of studying the job roles required for performing run-of-the-mill sets of initiatives or operations inside a set of vertical markets. at the equal time, it considered a pass to implement horizontal enterprise roles inside common businesses’ IT environments, together with procurement, finance and administration, consumer provider, and human substances. the brand modern workplace options deliver built-in utility sets that meet at that nexus; for example, programs to provide fork banking or retail reclaim administration features.

    “They’ve taken classes out of IBM’s functions neighborhood and . . . they believe got designed these applications to fabricate those people with the well-known thing company roles more valuable,” says Robert Mahowald, research supervisor at IDC. That should still, the reasoning goes, fabricate those agencies that adopt those options greater a success.

    because the solutions and IBM location of travail products assist traffic necessities, together with Java and XML, other products will too subsist built-in with other systems as well. IBM location of travail includes Lotus office, WebSphere Portal, Lotus Notes and Domino, and WebSphere Everyplace, based on the company’s internet web site.

    “Our focal point is on organizational productiveness,” says Bowden, including, “Having a competitive allotment is not as splendid as having a sustainable competitive facet.”

    actually, imposing entire integrated methods according to the capabilities that a company must effect as neatly because the roles of the individuals who effect the quintessential tasks, and proposing that to purchasers in a solution package it truly is the next neatest thing – or so IBM officers hope – to a turnkey solution, offers that sustainable area, traffic executives location up.

    The options don’t attain every miniature thing. Implementation particulars continue to subsist but IBM’s intent is to recall allotment of the ache out of the routine for little and medium-sized corporations that don’t believe a division committed to proposing IT. “Why don’t they collect you 70 percent of the way?” asks Bowden rhetorically.

    in a separate of IBM’s demonstration situations, a fiscal institution fork teller receives a sizable assess and wishes to gain the approval of a client carrier person, and additionally must pellucid the deposit for regulatory compliance and auditing. The fork banking solution provides job roles for 3 distinctive worker assignment units to meet the necessary traffic services. certainly, the brand modern office options embody greater than 30 job features or worker roles, company spokespeople referred to.

    among the many areas where IBM is providing modern office solutions are: retail, electronics, manufacturing, finance, telecommunications, executive, lifestyles sciences, healthcare and car groups. additionally, the enterprise has updated its fork Banking reply in addition to its traffic Controls and Reporting reply (now at edition 2.5).

    essentially, however, IBM is taking a a bit distinct tack on coopetition. To businesses fancy Oracle, SAP and PeopleSoft, “They’re asserting, ‘we’re going to deliver the plumbing for you,’” says IDC’s Mahowald, leaving a allotment of the pie for other players.

    IBM will too start providing on claim internet conferencing next month, officers stated. “when you believe a browser and a phone, you can installation an internet conference,” Bowden says. “as a substitute of purchasing the application from us, you could simply buy the carrier.” This comes as a direct try to recall traffic far from Microsoft’s are animate assembly, says Mahowald.

    in addition, IBM too introduced a modern product within the location of travail family unit. IBM workplace services express v2.0 is a fresh product designed for little and mid-sized groups and departments in enormous organizations. It includes crew collaboration, document administration, net types, chore lists, and portal functions as smartly person customization aspects. IBM office capabilities specific too integrates with the user's latest functions and data, in addition to email, calendar and maneuver publication, and provides quite a number collaboration outfit including built-in speedy messaging. it is going to ship in December, officers noted.

    eventually, IBM debuted the latest release of WebSphere Portal – version 5.1 – which adds digital portals, enterprise technique workflow points, and more suitable content material administration capabilities. edition 5.1 may subsist obtainable via the discontinue of November.

    The enterprise will proclaim pricing for totality the items and features when the items can subsist found, company officials talked about.

    about the author

    Stuart J. Johnston has lined expertise, certainly Microsoft, considering that February 1988 for InfoWorld, Computerworld, suggestions Week, and computing device World, as well as for traffic Developer, XML & internet services, and .net magazines.


    How attain They advocate SOA? | killexams.com actual Questions and Pass4sure dumps

    This chapter is from the e-book 

    A carrier-Oriented architecture (SOA) is without vicissitude an IT architectural vogue that permits applications to subsist developed to steer brand modern traffic wants of flexibility and integration. Flexibility allows for a enterprise to change and adapt. Integration emphasizes the communication and interaction of traffic techniques from end-to-conclusion, each internally and externally with consumers and suppliers.

    IBM WebSphere Portlet factory is a allotment of the IBM SOA groundwork and helps the "gather phase" of the SOA lifestyles cycle. establishing a SOA utility in reality includes making a carrier provider model and a provider buyer model. additional SOA elements encompass disconnected steer via stub service fashions, computerized provider checking out, simple carrier documentation, dynamic provider mapping, and repair interface assist.

    IBM WebSphere Portal is allotment of the IBM SOA foundation and helps the "set up phase" of the SOA life cycle. The installation allotment contains a blend of growing the hosting ambiance to your functions and in reality deploying these purposes. IBM WebSphere Portal is a internet hosting atmosphere for the person interaction splendid judgment of your SOA application. IBM WebSphere Portal offers you the user interface to SOA. extra SOA facets encompass getting access to internet capabilities from portlets, web capabilities for faraway portlet (WSRP), integrating traffic processes, and composite purposes.

    by using connecting/integrating a company's elements including people, functions, enterprise approaches, and content material, IBM WebSphere Portlet manufacturing unit and IBM WebSphere Portal construct portals that deliver comprehensive interplay and collaboration capabilities.


    IBM Beefs Up WebSphere Portal Collaboration | killexams.com actual Questions and Pass4sure dumps

    IBM has introduced modern application designed to fabricate it easier for agencies and reply suppliers to strengthen and combine net portal applied sciences. This indicators additional enhancements to IBM's WebSphere Portal, which now includes out-of-the-box rapid messaging, web conferencing, and americans finder tools inside WebSphere Portal's Collaboration core. The Collaboration middle can now subsist downloaded from the IBM WebSphere Portlet Catalog (www.ibm.com/WebSphere/portal/portlet/catalog). The Collaboration heart within WebSphere Portal will permit users to extra with ease discover, speak, and travail with colleagues. The capabilities recall skills of IBM Lotus utility to prolong WebSphere Portal's current collaborative services. They enable users to interact with distinct collaboration purposes including company white pages, organizational charts, speedy messages, crew workplaces, and virtual meetings. moreover, IBM and its enterprise partners believe lately published over 200 modern portlets and portlet builders to its WebSphere Portal Catalog, bringing the entire of portlets available inside the catalogue to over 900. the modern portlets and portlet builders consist of odds administration, collaboration, and search/retrieval purposes. they could push such items as stock tickers, climate forecasts, calendars and word bulletins to a desktop by means of the portal, or subsist clicked on to relate users to very own productivity, core company, or collaborative purposes. too blanketed within the Portlet Catalog is Bowstreet's Portlet manufacturing facility for WebSphere Portal, which is being resold via IBM. The Portlet manufacturing unit extends WebSphere Studio with tools to simplify the building and upkeep of custom-made, dynamic portal functions, enabling building teams to boost productiveness and in the reduction of time to implementation. It should subsist validated to integration standards laid out within the IBM equipped for WebSphere Studio software. nowadays, over a hundred and seventy application businesses are developing portlets for WebSphere Portal, together with 45 application corporations that believe recently agreed to create portlets to more tightly hyperlink their software functions to WebSphere Portal expertise for a extensive ambit of industries.

    IBM additionally now providing utility Portlet Builder for Domino. This solution will permit traffic clients to construct portlets round commercial enterprise software functions in line with IBM Lotus Domino, and permit administrators to customize its emerge and believe. IBM presents distinctive utility portlet builders for IBM and third-birthday celebration applications, totality of which permit portlets developed with it to subsist privy to individuals lively on quick messaging and to permit Click2Action counsel sharing between portlets.

    (http://www.ibm.com)


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    Taking a fresh peep at content and collaboration | killexams.com actual questions and Pass4sure dumps

    Collaboration technologies, such as Microsoft's SharePoint and IBM/Lotus Notes Domino, are hardly new. The latest version of these platforms – particularly in the case of SharePoint – has undergone theatrical change with modern search features and a consistent API for client, server, intranet and the Internet to cite just a few.

    SharePoint Server 2007, released ultimate fall, arrives at a time when corporations are focused on regulatory compliance and a modern generation of blog and wiki users is entering the workforce. To date, most corporations employ SharePoint for workgroup collaboration. But Peter O'Kelly, a senior analyst at the Burton Group, a consulting firm in Midvale, Utah, told SearchWinIT.com that IT managers working hard to collect control of their content should recall a fresh peep at today's collaboration tools for enterprise content management.

    SearchWinIT.com: SharePoint has been around for a long time. Why should IT shops pay attention now?

    Peter O'Kelly: The most well-known change is the level of integration that has taken place. Proprietary tools today travail in silos – records management, Web content management, file management. So, if you're already committed to Windows Server, SQL Server and maybe Exchange, [then adding SharePoint] will give you splendid synergy. Also, it's not just about IT managers working with confidential tools and services but too discontinue users being able to employ a browser and [Microsoft Office] instead of being trained on specialized tools.

    But [SharePoint] is not for everybody. If you exigency to race Linux, if you are primarily a Java shop from an application progress standpoint, then you can't play.

    Has SharePoint caught up to Notes in terms of its corporate entrenchment?

    O'Kelly: SharePoint may subsist 'stealthy,' but it is well used. There are two elements to SharePoint: One is Windows SharePoint Services, which is free, although you attain exigency a SQL Server CAL [client-access license] to attain anything meaningful. Then there is the product you pay for, which until 2007 was called SharePoint Portal Server 2003. Now it's called Microsoft Office SharePoint Server 2007. Microsoft says it has sold more than 85 million CALs. Notes is the most broadly deployed incumbent today with about 130 million [CALs], but Notes has been out there since 1989.

    There is a chain of major advances with [SharePoint] 2007. With [SharePoint] 2003, most people thought of it as a department-level portal. They employ it for basic workspaces, document libraries and team discussions. With 2007, the product is more credible for enterprise content management. SharePoint is really the server side component for Microsoft Office. Instead of using file servers, you will capture content [in SharePoint].

    So you can supersede a lot of individual tools by using these platforms?

    O'Kelly: There are things you can attain with SharePoint, such as records management and workflow. Organizations employ file servers to share files among applications. But file servers are not splendid for people. With people, it's better to proceed with a Web-centric view where you don't believe to copy files to a file server. It's not a replacement for a file system fancy SQL Server.

    There is a stark reality for a lot of organizations and that is large, publicly traded companies are out of compliance. fancy Y2K, you believe to inventory and fix this stuff. But the reality is companies don't believe control over their content -- and not just documents.

    There are things in database management systems, but historically those are more transaction-oriented document management systems. The vast majority of content today is on file servers, or local hard disks or email and email with file attachments. totality of that needs to collect under control. [Regulatory] compliance is helping.

    What about the corporate cultural barriers that might preserve companies from adopting these tools?

    O'Kelly: This has been the biggest challenge. If you don't travail in an organization that fosters collaboration, then you are wasting your money. You espy this sort of thing in sales where the person who sits next to you would just as soon assassinate you than give you information. It's easier for people who are modern to the workforce who are already doing this stuff. Some of them will find their pass to SharePoint.

    They Come to travail and want to employ blogs and wikis and would rather not believe a rogue open source project under their desk.

    Will IT shops believe to invest a lot of time in training discontinue users?

    O'Kelly: What they exigency to attain is collect people to unlearn some things. In the past they've had to copy and paste, but people naturally default to email and file attachments. That's why blogs and wikis are so popular. They are consistent with the pass people work. It's a breakthrough of simplicity.

    Compare IBM and Microsoft collaboration strategies. How attain you pick between them?

    O'Kelly: Start at the top. How much attain you keeping about things fancy Java and advocate for non-Microsoft platforms? attain you keeping about non-Microsoft server platforms and non-Microsoft developer tools? If you do, you exigency to peep at more competitive alternatives.

    So recall that out of the equation. What I'm looking for is browser-oriented content and collaboration, and I believe an email strategy so I'm not looking for an email strategy with content and collaboration. So then it's SharePoint versus [IBM] WebSphere Portal. WebSphere Portal will soon subsist extended with QuickR [file sharing software], which is an effortless to travail with browser-based experience. There is too Oracle WebCenter, though it has almost zero brand and market awareness.

    [Now, take] it further. I exigency to advocate multiple wealthy client platforms. I believe Windows, Mac and Linux and I exigency to recall travail offline. Then you believe to proceed down a path where Notes looks unique. Notes and [Microsoft] Groove are the only products now that can recall things offline for content management.

    If I'm leaning toward IBM, attain I proceed with a WebSphere core or a Notes/Domino core? IBM's biggest challenge is market perception of its products. Notes is not seen as obsolete but a late-in-life product. With the release of Notes 8, IBM needs to collect people to recall a peep so they can espy it's not a 1990s piece of software.


    Is Obama Ready To subsist A Two-Way President? | killexams.com actual questions and Pass4sure dumps

    Where there’s victory, there’s too opportunity…

    This Presidential election was profound in its results. Obama won both the Electoral College vote 364 to 163 and the well-liked vote 53% to 46% with roughly 120,000,000 votes cast. This election was the first in 50 years, in which there was no incumbent President or Vice President from either party competing for the Presidential nomination. near to 65% of the American population voted in this election, its highest turnout since the election of 1908.

    With Obama’s wins in key “swing states” including Ohio, Florida, Colorado, and Pennsylvania, this election was nothing short of a landslide victory that fundamentally redrew America’s political dynamics. A Democrat had not won Virginia and Indiana in a generation.

    Credit: CNN

    But let’s examine the election another way, one that may bring to life a different picture of how Obama earned his location in history. His crusade both redrew political lines and too forever changed the pass candidates achieve out to constituents.

    Online tools such as Facebook, MySpace, and Twitter contributed to the netting of record-breaking crusade funding and the staggering galvanization of a younger generation of first-time voters who truly made an repercussion and a difference. The Obama campaign, for example, outspent McCain nearly three-to-one, which was a testament to the capabilities of technology and the corresponding repercussion of sociology let slack on the Web. The Obama crusade leveraged multiple technology platforms and convivial immersion strategies to engage constituents directly, raising an astounding $660 million in crusade contributions.

    They went directly to the people.

    The Obama team, for case befriended almost 130,000 friends on Twitter with an almost equal amount following him.

    On Facebook, the Obama page boasted over three million fans compared to McCain’s 618,000.

    YouTube too swayed towards Obama with a network of 358,000 to 191,000, with the Obama camp posting over 1,800 videos compared to McCain’s 330. These videos accounted for 110 million views.

    If you compare the other convivial networks and communities from FriendFeed to MySpace to Flickr, the stats are asymmetrical in Obama’s partiality.

    Many of these two-way tools however, were simply used as broadcast mechanisms to route updates, solicit contributions, provide updates, and to too rally and unite supporters, albeit successfully.

    Reaching the other 46%

    My question is: What if these selfsame convivial media tools where deployed to not only communicate “to” constituents, but too to listen and interact with supporters as well as those who don’t currently endorse the President-elect?

    Over 46% of America voted against Barrack Obama, with 22 states going to John McCain, regardless of weight in the Electoral College. Either pass you peep at it, that’s noiseless a significant portion of America who didn’t believe #change or #hope were attributes of the Obama campaign. These voters believed their future lay with another candidate.

    Whether you’re a Democrat, Republican, Independent or member of the Green Party, you cannot overlook the power of actual world community relations combined with the achieve and engagement of online convivial communities and networks to change politics as usual.

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    I question you to believe - not just in my competence to bring about change, but in yours. I know this change is possible…because in this campaign, I believe had the privilege to witness what is best in America.

    Change.gov is the first step in a long road of reshaping the dynamics of politics and communication with voters.

    They’re on the perquisite track however.

    Obama’s history-making crusade that fused community relations with convivial sciences, after all, carried him to the Democratic nomination and too the Oval Office. Mr. Obama and his team believe cultivated and collaborated with a database of millions of people that spans a sophisticated contact relationship management infrastructure that spans across the actual world to totality well-liked convivial networks.

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    Other opportunities to engage with citizens online include:

    - Launch a convivial network at Change.gov and/or whitehouse.gov

    - Create a citizen feedback and collaboration page at GetSatisfaction

    -Solicit policy proposals that people can vote up or down on Change For Us.

    - Open the blog to comments on Change.gov (with community moderation).

    - Address the country on YouTube with updates, polls, and too address issues in between official situation of the Union broadcasts.

    - Capture behind-the-scenes footage of the inner workings of the White House and share across totality video networks.

    - Create a user-generated channel on Magnify.net that features content from constituents.

    -Create an @obamacares or @whitehousecares account on Twitter and other micro-blogging communities to listen and respond directly within each network.

    - Complement the Presidential radio bespeak with a regular podcast or livecast on uStream.tv or BlogTalkRadio and too interact with the people online, in actual time.

    - Publish speeches and well-known policy documents on document networks such as Scribd and Docstoc to subsist shared and disseminated throughout blogs and personal convivial profile pages.

    (What other ideas attain you have? Add them to comments).

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    Treat us fancy customers

    Most, successful businesses around the world location customers at the heart of everything. Before the Web, for instance, Nordstrom built its engendering foundation on world-class, and now world famous, customer care.

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    The President can’t meet everyone, that’s just the reality. It’s human nature to disagree. This President-elect is not purporting to subsist perfect, but it seems he’s honestly willing to learn. With a national chief technology officer in place, combined with an informed engagement team versed in convivial sciences and psychology, he can employ technology and two-way channels to not only multiply economic efficiencies and boost education and media literacy, but too to “listen” to those influential beacons in order to continue to redraw, or potentially erase, party lines.

    In my techtopian dreams, I hope that these incredible networks remain a constant source of conversation to extend beyond campaigning, but too collaborative governance that unites people.

    It’s not about being Republican or a Democrat, it’s about representing the majority of the people, their views, passions, ambitions and struggles, in order to subsist a representative of the people for the people. This is Obama’s occasion to employ the tools and channels of today’s emerging voter demographics to rewrite the future of politics, while serving the best interests of the American people in the process.

    Sometimes the best advisors and cabinet members are the very people who elected that person into office, and maybe, just maybe, too those who voted against him in the first place.

    If the Obama camp reads this, I’m more than delighted to release @obamacares and @whitehouse cares on Twitter. I held them for you.

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    Whole-Brain Susceptibility-Weighted Thrombus Imaging in Stroke: Fragmented Thrombi prognosticate Worse Outcome | killexams.com actual questions and Pass4sure dumps

    Abstract

    BACKGROUND AND PURPOSE: The prevalence and clinical significance of primarily fragmented thrombi in patients with acute ischemic stroke remains elusive. Whole-brain SWI was used to detect multiple thrombus fragments, and their clinical significance was analyzed.

    MATERIALS AND METHODS: Pretreatment SWI was analyzed for the presence of a separate intracranial thrombus or multiple intracranial thrombi. Associations with baseline clinical characteristics, complications, and clinical outcome were studied.

    RESULTS: separate intracranial thrombi were detected in 300 (92.6%), and multiple thrombi, in 24 of 324 patients (7.4%). In 23 patients with multiple thrombi, totality thrombus fragments were located in the vascular territory distal to the primary occluding thrombus; in 1 patient, thrombi were organize both in the anterior and posterior circulation. Only a minority of thrombus fragments were detected on TOF-MRA, first-pass gadolinium-enhanced MRA, or DSA. Patients with multiple intracranial thrombi presented with more austere symptoms (median NIHSS scores, 15 versus 11; P = .014) and larger ischemic areas (median DWI ASPECTS, 5 versus 7; P = .006); splendid collaterals, rated on DSA, were fewer than those in patients with a separate thrombus (21.1% versus 44.2%, P = .051). The presence of multiple thrombi was a predictor of unfavorable outcome at 3 months (P = .040; OR, 0.251; 95% CI, 0.067–0.939).

    CONCLUSIONS: Patients with multiple intracranial thrombus fragments constitute a little subgroup of patients with stroke with a worse outcome than patients with separate thrombi.

    ABBREVIATION: SVS susceptibility vessel sign

    Little is known about the proportion of acute ischemic strokes caused by multiple intracranial thrombi. Rarely, distal thrombus fragments that are separate from the primary occluding thrombus can subsist detected on DSA. Incomplete vessel occlusion by the primary thrombus with distal passage of contrast is required for this observation. Therefore, the factual prevalence of multiple intracranial thrombi in the stroke population and the implications for clinical outcome remain unknown.

    Advanced gradient-echo-based MR imaging sequences, such as SWI, are highly sensitive in distinguishing structures that believe different susceptibility values than their surroundings (eg, deoxygenated blood, hemosiderin, ferritin, or calcium).1 SWI offers the possibility to directly visualize thrombotic material, commonly referred to as the susceptibility vessel token (SVS), independent of the presence of blood flood or contrast media.2⇓–4 Recent studies confirmed that 1.5T and 3T SWI is a fast, robust, and highly sensitive imaging technique in acute stroke without germane image interference following gadolinium application.5,6 They performed SWI, covering the all brain in patients with acute ischemic stroke of the anterior or posterior circulation to determine the prevalence of multiple intracranial thrombi before thrombolytic treatment and to study the associations between the presence of fragmented thrombi and baseline clinical and imaging characteristics, stroke etiology, and clinical outcome.

    Materials and Methods Patients and Clinical Data

    Five hundred fifty-seven patients with acute ischemic stroke treated at their stroke unit from January 2010 to August 2013 underwent MR imaging after admission. Of these, 442 patients had MR imaging including SWI before initiation of thrombolytic therapy. Patients with anterior or posterior circulation stroke due to tandem occlusions (ICA and MCA), carotid-T occlusions, isolated occlusions of the MCA (M1, M2, or M3/4 segments), occlusions of the anterior cerebral artery, occlusions of the basilar artery either isolated or in combination with the vertebral artery, and occlusions of the posterior cerebral artery were considered for the final analysis. Three hundred forty-seven patients fulfilled totality inclusion criteria. Following the imaging, totality patients underwent recanalization therapy with IV rtPA, endovascular techniques, or a combination of both.

    Clinical data were continuously recorded in the data groundwork of their stroke center. The affliction of Org 10172 in Acute Stroke Treatment criteria were used for the categorization of stroke etiology.7 The happening of symptomatic and asymptomatic intracranial hemorrhage, within 72 hours from stroke onset, was recorded according to the Prolyse in Acute Cerebral Thromboembolism II criteria.8 Clinical outcome was assessed 3 months after stroke by using the modified Rankin Scale. The study was approved by their institutional review board.

    Imaging

    Standard stroke MR imaging protocol was performed, which included diffusion-weighted imaging, T2-weighted imaging, TOF-MRA, SWI, first-pass gadolinium-enhanced MRA of the cervical and intracranial arteries, and perfusion imaging. The scans were acquired on 1.5T and 3T MR imaging systems (Magnetom Avanto and Magnetom Verio; Siemens, Erlangen, Germany).

    For the 1.5T scanner, the SWI parameters were the following: TR, 49 ms; TE, 40 ms; number of averages, 1; FOV read, 230 mm; FOV phase, 75.0%; voxel size, 0.9 × 0.7 × 1.8 mm; flip angle, 15°; acquisition time, 2 minutes 59 seconds. For the 3T scanner, the parameters were as follows: TR, 28 ms; TE, 20 ms; number of averages, 1; FOV read, 230 mm; FOV phase, 75.0%; voxel size, 0.9 × 0.9 × 2.0 mm; flip angle, 15°; acquisition time, 2 minutes 59 seconds. The SWI and minimum-intensity-projection images were generated automatically by the scanner software.

    DSA was performed via a transfemoral approach by using a biplane, high-resolution angiographic system (Axiom Artis zee; Siemens).

    Image Analysis

    MR images were interpreted in consensus by a neuroradiologist and a radiologist in training. SWI was analyzed for the presence of the SVS in the supraclinoid segment of the ICA, the MCA, the anterior cerebral artery, the intradural segment of the vertebral artery, the basilar artery, and the posterior cerebral artery. The SVS was defined as an district of signal drop within the course of an artery that either exceeded the diameter of the contralateral nonoccluded vessel or that of the adjacent vessel segment on both the SWI and minimum-intensity-projection series.3 The length of the main thrombus and distal thrombus fragments, if applicable, was measured on SWI. In case of carotid-T, tandem, and combined basilar artery and vertebral artery occlusions, total clot length could not subsist determined because of either susceptibility artifacts in the proximity of the skull groundwork or thrombi located partially outside the FOV.

    A distal thrombus fragment was defined as an SVS being separated from the more proximal SVS by >2 mm—that is, the largest dimension of a voxel in SWI (Figs 1 and 2). The distance between the primary occluding thrombus and distal thrombus fragments was measured on a reconstructed plane, including both the distal allotment of the primary occluding thrombus and the proximal allotment of the thrombus fragment.

    Fig 1.

    An 85-year-old man with right-sided hemiparesis and aphasia (NIHSS 13). Pretreatment SWI shows susceptibility vessel signs in the left M1 and M2 segments (A, white arrows). On TOF-MRA (MIP), diminished flood signal is seen distal to the thrombus fragment in the M1 segment with complete loss of flood signal at the site of the distal thrombus fragment (B, white arrowheads). DSA demonstrates incomplete occlusion of the vessel lumen by a thrombus in the M1 segment (C, anteroposterior projection, black arrowhead). On the lateral projection, occlusion of the temporo-occipital M2 fork by a more distal thrombus fragment is visible (D, black arrow). Although both TOF-MRA and DSA can bespeak the distal vessel occlusion, only SWI allows estimation of the length of the distal fragment and exclusion of additional distal thrombi.

    Fig 2.

    A 69-year-old male patient with a sudden abate in consciousness. SWI shows susceptibility artifacts from thrombotic material in the basilar artery (A, white arrow) and the perquisite posterior cerebral artery (B, white arrowhead). Hemorrhagic transformation of a subacute infarction in the vascular territory of the perquisite posterior cerebral artery is seen. DSA confirms occlusion of the basilar artery (C, anteroposterior projection, black arrowhead). Following successful endovascular recanalization of the basilar artery, the occlusion in the perimesencephalic segment of the perquisite posterior cerebral artery, already known from pretreatment SWI, becomes visible in DSA as well (D, anteroposterior projection, black arrow).

    In patients with anterior circulation stroke, with the exception of the 4 patients with isolated anterior cerebral artery occlusion, the extent of ischemic lesions was assessed on pretreatment DWI by using the Alberta Stroke Program Early CT Score.9

    Leptomeningeal collaterals were assessed on DSA as described previously.10

    Statistical Analysis

    Categoric variables were compared with the χ2 test and the Fisher exact test as appropriate, and continuous variables, with the Mann-Whitney U test. To determine the predictors of clinical outcome, they performed a forward stepwise logistic regression, including totality variables with a P < .2 in univariate analysis. These variables were age, sex, baseline NIHSS score, occlusion site, degree of collaterals, DWI ASPECTS, atrial fibrillation, diabetes mellitus, arterial hypertension, hypercholesterolemia, coronary artery disease, current smoking, and the presence of multiple intracranial thrombi on pretreatment imaging. Clinical outcome was dichotomized into conducive (mRS 0–2) and destitute outcome (mRS 3–6). Collateral status was dichotomized into splendid and moderate/poor collaterals. A P value < .05 was considered significant. Statistics were performed with SPSS, Version 21 (IBM, Armonk, modern York).

    Results

    The SVS was detected in 324 of 347 patients (93.4%) on pretreatment SWI. Multiple intracranial thrombi were organize in 24 patients (7.4% of totality patients with visible SVSs). Fragmented thrombi occurred with a similar frequency in anterior and posterior circulation strokes (3/36 [8.3%] versus 21/288 [7.3%], P = .739). Nineteen patients had 1 distal fragment, 3 had 2 fragments, and 2 had 3 fragments. One of 31 fragments was located in the M1 segment of the MCA; 15, in the M2 segment; 11, in the M3 or M4 segment; 2, in the P2 segment of the posterior cerebral artery, and 2, in the P3 segment. Thirty thrombus fragments were organize in the vascular territory distal to the primary occluding thrombus. One patient with a carotid-T occlusion was organize to believe a thrombus fragment in the P3 segment of the ipsilateral posterior cerebral artery, most likely by distal migration through a fetal variant of the posterior cerebral artery.

    The value distance of thrombus fragments from the primary occluding thrombus was 19.6 ± 15.6 mm. The value length of thrombus fragments was 7.1 ± 4.0 mm.

    TOF-MRA and first-pass gadolinium-enhanced MRA detected distal thrombus fragments in 8 and 11 of 24 patients (25.0% and 33.3%, respectively), with multiple intracranial thrombi on SWI. Nineteen of the 24 patients with multiple intracranial thrombi on SWI underwent DSA. In this group, thrombus fragments were confirmed in 8 patients (42.1%) on DSA.

    Baseline clinical characteristics of patients with fragmented and separate thrombi are shown in Table 1. Patients with multiple intracranial thrombi presented with a significantly higher median NIHSS score on admission (15 versus 11, P = .014). No significant discrepancy in vascular risk factors or stroke etiology was organize between the 2 groups. The prestroke employ of antiplatelet drugs or anticoagulants did not disagree between the groups. Imaging characteristics and treatment are compared in Table 2. In patients with isolated MCA, anterior cerebral artery, basilar artery, and posterior cerebral artery occlusions, total clot length was determined. Clot length in patients with fragmented thrombi was significantly higher than that in patients with a solitary thrombus (20.1 ± 10.7 versus 10.3 ± 5.6 mm, P < .001).

    Table 1:

    Baseline clinical characteristics

    Table 2:

    Imaging characteristics and treatment

    Patients with fragmented thrombi had significantly lower median DWI ASPECTS, acceptation larger ischemic areas on DWI, than patients with a solitary thrombus (5 versus 7, P = .006). splendid collaterals as assessed on DSA were organize in fewer patients with fragmented thrombi than in those without, but the discrepancy was not significant (4/19 [21.1%] versus 88/199 [44.2%], P = .051). One hundred eight patients (33.3%) were treated with IV rtPA alone, 140 (43.2%) underwent endovascular treatment, and 76 (23.5%) had a combination of both. Treatment was similar in both groups. Clinical outcome at 3 months was worse in patients with fragmented thrombi (mRS 0–2: 6/23 [26.1%] versus 171/286 [59.8%]; P = .002; Table 3).

    Table 3:

    Intracranial bleeding complications and clinical outcome

    The following variables showed P < .2 in univariate analysis and were included in the binary logistic regression analysis: NIHSS, age, DWI ASPECTS, multiple intracranial thrombi on pretreatment imaging, occlusion site, atrial fibrillation, diabetes mellitus, arterial hypertension, coronary artery disease, and current smoking. In their stepwise regression model, NIHSS was included as the first variable, followed by age, DWI ASPECTS, and finally the presence of multiple thrombi. The absence of multiple thrombus fragments (P = .040; OR, 0.251; 95% CI, 0.067–0.939), higher DWI ASPECTS (P = .004; OR, 1.328; 95% CI, 1.093–1.614), younger age (P < .001; OR, 0.919; 95% CI, 0.889–0.950), and lower NIHSS score (P < .001; OR, 0.832; 95% CI, 0.773–0.894) predicted splendid outcome.

    Discussion

    Using whole-brain SWI, they organize multiple intracranial thrombi in 24 of 324 patients with acute stroke with the SVS (7.4%) before initiation of any thrombolytic therapy. Most distal thrombus fragments (95.8%) affected the selfsame vascular territory distal to the proximal occluding thrombus and were therefore a priori invisible with run-of-the-mill angiographic techniques. They organize significant associations between the presence of multiple intracranial thrombi and a higher NIHSS score on admission as well as larger ischemic areas on pretreatment DWI. The presence of fragmented thrombi was a predictor of unfavorable clinical outcome at 3 months.

    A study that analyzed the histologic structure of clots extracted by endovascular means by using the Merci retriever (Concentric Medical, Mountain View, California) reported that in 64% of cases, thrombi were retrieved in multiple fragments.11 It is likely that the prevalence of fragmented thrombi had been lower before mechanical disruption of the clot during deployment and retraction of the thrombectomy device. This supposition is supported by their in vivo studies demonstrating thrombus fragmentation and distal embolization during retrieval of the initially separate thrombus with distal thrombectomy devices.12

    Although their results are based purely on thrombus fragmentation before thrombolytic treatment, it could subsist speculated that iatrogenic thrombus fragmentation might believe a similarly negative repercussion on outcome. This may, among other contributing factors, justify the disappointing clinical outcome in studies that used thrombus fragmentation techniques exclusively (Multi Mechanical Embolus Removal in Cerebral Ischemia, Penumbra Pivotal Stroke Trial, Mechanical Retrieval and REcanalization of Stroke Clots Using Embolectomy trials)13⇓–15 or in allotment (Interventional Management of Stroke III, SYNTHESIS Expansion [A randomized controlled affliction between loco-regional intra-arterial and systemic intravenous thrombolysis with Alteplase in acute ischemic stroke]).16,17 The SYNTHESIS Expansion study reported that thrombus fragmentation with a microguidewire was performed in approximately two-thirds of patients.17 In contrast, the goal of current mechanical thrombectomy in acute stroke is removal of the thrombus en bloc with the lowest viable rate of thrombus fragmentation, as applied and improved in experienced stroke centers.10,18,19

    In their series, splendid collaterals as assessed on DSA were organize in fewer patients with multiple intracranial thrombi, though the discrepancy was not significant. No additional differences in other well-known predictors of outcome were organize between patients with and without multiple thrombi. There is evidence from multiple studies that splendid leptomeningeal collaterals reduce and leisurely penumbral tissue loss, resulting in better clinical outcome.20,21 When one considers the differences in collateral status between patients with and without multiple fragments, the probable role of autolysis should subsist discussed. Zanette et al22 reported that involuntary lysis occurs in a tall percentage of patients with distal MCA occlusions, similar to the sites where most of the distal thrombus fragments were organize in their cohort. Because splendid collaterals were seen less often in patients with multiple thrombus fragments than in those with a separate thrombus, one could hypothesize that fewer endogenous thrombolytic factors may believe reached the distal thrombus fragments in patients with destitute collateralization, resulting in the persistence of these fragments.

    Thrombus affliction must subsist taken into account when looking for factors that could justify the differences in outcome. Total clot length, defined as the combined length of the primary occluding thrombus and the distal thrombus fragments, was significantly higher in patients with fragmented thrombi compared with those with a solitary thrombus. It remains unclear whether longer thrombi are more likely to fragment or distal fragments lead to secondary clot formation due to stagnation of blood flow, thus increasing total clot length. A recent study assessed clot affliction in patients with anterior circulation stroke on T2*-weighted imaging by using a scoring system based on the vessel segments that were affected by thrombotic material. Patients with fewer and more distal vessel segments involved had a higher revascularization rate and were more likely to believe conducive clinical outcome.23 Because absolute thrombus length was not allotment of the scoring system, the comparability with their results is limited. One has to deem that assessment of thrombus affliction by measuring the total length of thrombus fragments could result in overestimation in patients with multiple thrombi. Migration of distal thrombus fragments to smaller-sized vessels may result in reorientation and elongation of distal thrombi, resulting in a total clot length disproportionate to total clot volume.

    TOF-MRA, first-pass gadolinium-enhanced MRA, and DSA detected only a minority of distal thrombus fragments seen on SWI. The lower succumb of these imaging techniques in the detection of distal thrombus fragments most likely results from their dependence on the presence of blood flood or contrast media, both of which are usually reduced or absent distal to the primary vessel occlusion. Besides DWI and imaging of the all angioarchitecture from the aortic arch up to distal branches of the cerebral arteries, imaging of the thrombus and its fragments with SWI has become a standard sequence of their stroke protocol due to its tall therapeutic relevance.5

    Our study has some limitations. Image analysis was only performed in consensus. In their experience, the SVS and distal thrombus fragments are easily detectable and they did not deem it necessary to additionally assess interobserver variability. Furthermore, each MR imaging study was routinely evaluated by a neuroradiologist and radiologist in training, and the findings were documented in their PACS. In 16 of the 24 patients (66.7%) with multiple thrombi on SWI, a distal vessel occlusion or thrombus fragment or both separate from the primary occlusion had already been described in the radiology report. Most interesting, in the 8 patients in whom distal thrombus fragments were not described initially, the fragments were located in closer proximity to the primary thrombus than in those in whom the distal occlusion was mentioned (7.0 ± 4.0 versus 24.2 ± 15.9 mm). One could speculate that these fragments were either harder to detect or had not been considered well-known enough to subsist described in the radiology report. In this single-center study, data from imaging were partly analyzed retrospectively. The little size of the patient group with fragmented thrombi limits the generalizability of the results. Evaluation of ICA and basilar artery thrombi on SWI was greatly limited by the extensive susceptibility artifacts in the proximity of the skull base.

    Conclusions

    Multiple intracranial thrombi were detected on pretreatment SWI in 7.4% of patients with acute ischemic stroke of the anterior or posterior circulation. The presence of fragmented thrombi was a predictor of worse outcome. Patients with multiple thrombus fragments presented with more austere symptoms on admission, had more extensive ischemic areas on pretreatment DWI, and demonstrated worse collaterals as seen on biplane angiography. To know that multiple thrombi are present not only helps in planning the endovascular treatment, especially mechanical thrombectomy because distal fragments render the intervention more difficult, but may too subsist of employ in prognostication of functional outcome.

    Acknowledgments

    We thank Pietro Ballinari for statistical advice.

    Footnotes
  • Disclosures: Jan Gralla—UNRELATED: Consultancy: Covidien,* Comments: Global Principal Investigator of the Solitaire FR Thrombectomy for Acute Revascularization Study and consultant for Covidien. Heinrich P. Mattle—UNRELATED: Consultancy: Bayer, Biogen, Boehringer Ingelheim, Daiichi-Sankyo, Genzyme, Merck, Neuravi, Novartis, Pfizer, Teva; Grants/Grants Pending: Swiss Heart Foundation,* Swiss National Science Foundation*; Payment for Lectures (including service on Speakers Bureaus): Bayer, Biogen, Boehringer Ingelheim, Covidien, Daiichi Sankyo, Genzyme, Neuravi, Novartis, Pfizer; Royalties: for textbooks on neurology I believe written. *Money paid to the institution.

  • Paper previously presented in allotment at: XXIII European Stroke Conference, May 12–15, 2014; Nice, France.

  • Received October 24, 2014.
  • Accepted after revision December 11, 2014.


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