Value of Thrombus CT Characteristics in Patients with Acute Ischemic Stroke

J. Borst*, O. A. Berkhemer, E. M. M. Santos, A. J. Yoo, M. den Blanken, Y. B. W. E. M. Roos, E. van Bavel, W. H. van Zwam, R. J. van Oostenbrugge, H. F. Lingsma, A. van der Lugt, D. W. J. Dippel, H. A. Marquering, C. B. L. M. Majoie, MR CLEAN Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND AND PURPOSE: Thrombus CT characteristics might be useful for patient selection for intra-arterial treatment. Our objective was to study the association of thrombus CT characteristics with outcome and treatment effect in patients with acute ischemic stroke.

MATERIALS AND METHODS: We included 199 patients for whom thin-section NCCT and CTA within 30 minutes from each other were available in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) study. We assessed the following thrombus characteristics: location, distance from ICA terminus to thrombus, length, volume, absolute and relative density on NCCT, and perviousness. Associations of thrombus characteristics with outcome were estimated with univariable and multivariable ordinal logistic regression as an OR for a shift toward better outcome on the mRS. Interaction terms were used to investigate treatment-effect modification by thrombus characteristics.

RESULTS: In univariate analysis, only the distance from the ICA terminus to the thrombus, length of >8 mm, and perviousness were associated with functional outcome. Relative thrombus density on CTA was independently associated with functional outcome with an adjusted common OR of 1.21 per 10% (95% CI, 1.02-1.43; P = .029). There was no treatment-effect modification by any of the thrombus CT characteristics.

CONCLUSIONS: In our study on patients with large-vessel occlusion of the anterior circulation, CT thrombus characteristics appear useful for predicting functional outcome. However, in our study cohort, the effect of intra-arterial treatment was independent of the thrombus CT characteristics. Therefore, no arguments were provided to select patients for intra-arterial treatment using thrombus CT characteristics.

Original languageEnglish
Pages (from-to)1758-1764
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume38
Issue number9
DOIs
Publication statusPublished - Sep 2017

Keywords

  • STENT-RETRIEVER THROMBECTOMY
  • CEREBRAL-ARTERY OCCLUSION
  • INTRAVENOUS THROMBOLYSIS
  • SUCCESSFUL RECANALIZATION
  • MECHANICAL THROMBECTOMY
  • COMPUTED-TOMOGRAPHY
  • CLOT LENGTH
  • ATTENUATION
  • DENSITY
  • VESSEL

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