Clot Burden Score and Collateral Status and Their Impact on Functional Outcome in Acute Ischemic Stroke
- 12 November 2020
- journal article
- research article
- Published by American Society of Neuroradiology (ASNR) in American Journal of Neuroradiology
- Vol. 42 (1), 42-48
- https://doi.org/10.3174/ajnr.a6865
Abstract
BACKGROUND AND PURPOSE: Collateral status and thrombus length have been independently associated with functional outcome in patients with acute ischemic stroke. It has been suggested that thrombus length would influence functional outcome via interaction with the collateral circulation. We investigated the individual and combined effects of thrombus length assessed by the clot burden score and collateral status assessed by a FLAIR vascular hyperintensity–ASPECTS rating system on functional outcome (mRS). MATERIALS AND METHODS: Patients with anterior circulation acute ischemic stroke due to large-vessel occlusion from the ASTER and THRACE trials treated with endovascular thrombectomy were pooled. The clot burden score and FLAIR vascular hyperintensity score were determined on MR imaging obtained before endovascular thrombectomy. Favorable outcome was defined as an mRS score of 0–2 at 90 days. Association of the clot burden score and the FLAIR vascular hyperintensity score with favorable outcome (individual effect and interaction) was examined using logistic regression models. RESULTS: Of the 326 patients treated by endovascular thrombectomy with both the clot burden score and FLAIR vascular hyperintensity assessment, favorable outcome was observed in 165 (51%). The rate of favorable outcome increased with clot burden score (smaller clots) and FLAIR vascular hyperintensity (better collaterals) values. The association between clot burden score and functional outcome was significantly modified by the FLAIR vascular hyperintensity score, and this association was stronger in patients with good collaterals, with an adjusted OR = 6.15 (95% CI, 1.03–36.81). CONCLUSIONS: The association between the clot burden score and functional outcome varied for different collateral scores. The FLAIR vascular hyperintensity score might be a valuable prognostic factor, especially when contrast-based vascular imaging is not available.Keywords
This publication has 40 references indexed in Scilit:
- Thrombus Imaging Characteristics and Outcomes in Acute Ischemic Stroke Patients Undergoing Endovascular TreatmentStroke, 2019
- Does Clot Burden Score on Baseline T2*-MRI Impact Clinical Outcome in Acute Ischemic Stroke Treated with Mechanical Thrombectomy?Journal of Stroke, 2019
- Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic StrokeStroke, 2016
- Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation StrokeStroke, 2016
- Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trialsThe Lancet, 2016
- Collateral Vessels in Proximal Middle Cerebral Artery Occlusion: The ENDOSTROKE StudyRadiology, 2015
- Clot Burden Score on Admission T2*-MRI Predicts Recanalization in Acute StrokeStroke, 2013
- Collateral blood vessels in acute ischaemic stroke: a potential therapeutic targetThe Lancet Neurology, 2011
- Intracranial Thrombus Extent Predicts Clinical Outcome, Final Infarct Size and Hemorrhagic Transformation in Ischemic Stroke: The Clot Burden ScoreInternational Journal of Stroke, 2008
- The Impact of Recanalization on Ischemic Stroke OutcomeStroke, 2007