J Borst1, O A Berkhemer2,3, E M M Santos2,4,5,6, A J Yoo7, M den Blanken4, Y B W E M Roos8, E van Bavel4, W H van Zwam9, R J van Oostenbrugge10, H F Lingsma11, A van der Lugt5, D W J Dippel3, H A Marquering2,4, C B L M Majoie2. 1. From the Departments of Radiology (J.B., O.A.B., E.M.M.S., H.A.M., C.B.L.M.M.) j.borst@amc.uva.nl. 2. From the Departments of Radiology (J.B., O.A.B., E.M.M.S., H.A.M., C.B.L.M.M.). 3. Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands. 4. Biomedical Engineering and Physics (E.M.M.S., M.d.B., E.v.B., H.A.M.), Academic Medical Center, Amsterdam, the Netherlands. 5. Radiology (E.M.M.S., A.v.d.L.). 6. Medical Informatics (E.M.M.S.). 7. Department of Radiology (A.J.Y.), Texas Stroke Institute, Plano, Texas. 8. Neurology (Y.B.W.E.M.R.). 9. Departments of Radiology (W.H.v.Z.). 10. Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands. 11. Departments of Public Health (H.F.L.).
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.
RCT Entities:
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.
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