Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke

被引：50

作者：

Treurniet, Kilian M. ^{[1
]}

Yoo, Albert J. ^{[4
]}

Berkhemer, Olvert A. ^{[1
,5
,9
]}

Lingsma, Hester F. ^{[6
]}

Boers, Anna M. M. ^{[1
,2
,10
]}

Fransen, Puck S. S. ^{[5
,7
]}

Beumer, Debbie ^{[8
]}

van den Berg, Lucie A. ^{[3
]}

Sprengers, Marieke E. S. ^{[1
]}

Jenniskens, Sjoerd F. M. ^{[11
]}

Nijeholt, Geert J. Lycklama A. ^{[12
]}

van Walderveen, Marianne A. A. ^{[13
]}

Bot, Joseph C. J. ^{[14
]}

Beenen, Ludo F. M. ^{[1
]}

van den Berg, Rene ^{[1
]}

van Zwam, Wim H. ^{[9
]}

van der Lugt, Aad ^{[7
]}

van Oostenbrugge, Robert J. ^{[8
]}

Dippel, Diederik W. J. ^{[5
]}

Roos, Yvo B. W. E. M. ^{[3
]}

Marquering, Henk A. ^{[1
,2
]}

Majoie, Charles B. L. M. ^{[1
]}

机构：

[1] Acad Med Ctr, Dept Radiol, G1-235,POB 22660, NL-1100 DD Amsterdam, Netherlands

[2] Acad Med Ctr, Dept Biomed Engn & Phys, Amsterdam, Netherlands

[3] Acad Med Ctr, Dept Neurol, Amsterdam, Netherlands

[4] Texas Stroke Inst, Dept Radiol, Dallas, TX USA

[5] Erasmus MC, Univ Med Ctr, Dept Neurol, Rotterdam, Netherlands

[6] Erasmus MC, Univ Med Ctr, Dept Publ Hlth, Rotterdam, Netherlands

[7] Erasmus MC, Univ Med Ctr, Dept Radiol, Rotterdam, Netherlands

[8] Maastricht Univ, Med Ctr, Dept Neurol, NL-6200 MD Maastricht, Netherlands

[9] Maastricht Univ, Med Ctr, Dept Radiol, NL-6200 MD Maastricht, Netherlands

[10] Univ Twente, Dept Robot & Mechatron, Enschede, Netherlands

[11] Radboud Univ Nijmegen, Med Ctr, Dept Radiol, Nijmegen, Netherlands

[12] MC Haaglanden, Dept Radiol, The Hague, Netherlands

[13] Leiden Univ, Med Ctr, Dept Radiol, NL-2300 RA Leiden, Netherlands

[14] Vrije Univ Amsterdam Med Ctr, Dept Radiol, Amsterdam, Netherlands

来源：

STROKE | 2016年 / 47卷 / 12期

关键词：

intracranial embolism; neuroimaging; stroke; thrombectomy; thrombolytic therapy; ENDOVASCULAR TREATMENT; CT ANGIOGRAPHY; MECHANICAL THROMBECTOMY; STENT-RETRIEVER; THROMBUS LENGTH; SYMPTOM ONSET; RECANALIZATION; INFARCT; TRIAL; REPERFUSION;

D O I：

10.1161/STROKEAHA.116.014565

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-A high clot burden score (CBS) is associated with favorable outcome after intravenous treatment for acute ischemic stroke. The added benefit of intra-arterial treatment might be less in these patients. The aim of this exploratory post hoc analysis was to assess the relation of CBS with neurological improvement and endovascular treatment effect. Methods-For 499 of 500 patients in the MR CLEAN study (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), the CBS was determined. Ordinal logistic regression models with and without main baseline prognostic variables were used to assess the association between CBS (continuous or dichotomized at CBS of 6) and a shift toward better outcome on the modified Rankin Scale. The model without main baseline prognostic variables only included treatment allocation and CBS. Models with and without a multiplicative interaction term of CBS and treatment were compared using the chi(2) test to assess treatment effect modification by CBS. Results-Higher CBS was associated with a shift toward better outcome on the modified Rankin Scale; adjusted common odds ratio per point CBS was 1.12 (95% confidence interval, 1.04-1.20]. Dichotomized CBS had an adjusted common odds ratio of 1.67 (95% confidence interval, 1.12-2.51). Both effect estimates were slightly attenuated by adding baseline prognostic variables. The addition of the interaction terms did not significantly improve the fit of the models. There was a small and insignificant increase of intra-arterial treatment efficacy in the high CBS group. Conclusions-A higher CBS is associated with improved outcome and may be used as a prognostic marker. We found no evidence that CBS modifies the effect of intra-arterial treatment.

引用

页码：2972 / 2978

页数：7

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