J Stroke.
2019 Jan;21(1):91-100. 10.5853/jos.2018.01921.
Does Clot Burden Score on Baseline T2*-MRI Impact Clinical Outcome in Acute Ischemic Stroke Treated with Mechanical Thrombectomy?
- Affiliations
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- 1Department of Neuroradiology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France.
- 2Department of Neuroradiology, CHU Nantes, Nantes, France.
- 3Department of Biostatistics, CHRU Nancy, INSERM, University of Lorraine, Nancy, France.
- 4Department of Neuroradiology, CHU Reims, Reims, France.
- 5Paris Descartes University, INSERM UMR 894 and Department of Neuroradiology, Sainte-Anne Hospital Center, Paris, France. o.naggara@ch-sainte-anne.fr
- 6Department of CIC1433 Innovative Technology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France.
- 7Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
- 8Department of Neuroradiology, Foch Hospital, Suresnes, France.
- 9Department of Neuroradiology, CHU Rennes, Rennes, France.
- KMID: 2438653
- DOI: http://doi.org/10.5853/jos.2018.01921
Abstract
- BACKGROUND AND PURPOSE
A long clot, defined by a low (0-6) clot burden score (CBS) assessed by T2*-MR sequence, is associated with worse clinical outcome after intravenous thrombolysis (IVT) for acute ischemic stroke than is a small clot (CBS, 7-10). The added benefit of mechanical thrombectomy (MT) might be higher in patients with long clot. The aim of this pre-specified post hoc analysis of the THRombectomie des Artères CErebrales (THRACE) trial was to assess the association between T2*-CBS, successful recanalization and clinical outcome.
METHODS
Of 414 patients randomized in the THRACE trial, 281 patients were included in this analysis. Associations between T2*-CBS and clinical outcome on the modified Rankin Scale (mRS) at 3 months were tested.
RESULTS
High T2*-CBS, i.e., small clot, was associated with a shift toward better outcome on the mRS; proportional odds ratio (POR) per point CBS was 1.19 (95% confidence interval [CI], 1.05 to 1.34) in the whole population, 1.34 (95% CI, 1.13 to 1.59) in IVT group, and 1.04 (95% CI, 0.87 to 1.23) in IVTMT group. After adjustment for baseline prognostic variables, the effect of the full scale T2*-CBS was not statistically significant in the whole population and for the IVTMT group but remains significant for the IVT group (POR, 1.32; 95% CI, 1.11 to 1.58).
CONCLUSIONS
A small clot, as assessed using T2*-CBS, is associated with improved outcome and may be used as a prognostic marker. Despite the worst outcome with long clot, the relative benefit of MT over IVT seemed to increase with low T2*-CBS and longer clot.
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