Article Figures & Data
Figures
- Fig 1.
Illustration of CBS. A, A 10-point score is normal, implying absence of thrombus. Two points (as indicated) are subtracted for thrombus found on CTA in the supraclinoid ICA and each of the proximal and distal halves of the MCA trunk. One point is subtracted for thrombus found in the infraclinoid ICA and A1 segment and for each affected M2 branch. B, Occlusion of infra- and supraclinoid ICAs with a CBS of 7. C, Distal M1 and 2 M2 branch occlusions produce a CBS of 6. D, Occlusion of the terminal ICA, proximal M1, and A1, with a resultant CBS of 5.
- Fig 2.
MTT and CTA source images (CTA-SI) of 4 different cases, each demonstrating prolonged MTT from a left MCA territory ischemia. CS grading is demonstrated for each collateral grade. A, Absence of vessels on CTA-SI is consistent with a CS of 0. B, A score of 1 indicates collateral supply filling ≤50% but >0% of the occluded MCA territory. C, A score of 2 is given for collateral supply filling >50% but <100% of the occluded MCA territory. D, A score of 3 is given for 100% collateral supply of the occluded MCA territory.
- Fig 3.
ROC for CBS prediction of good clinical outcome (mRS score, ≤2). A threshold of >6.5 was found with an AUC of 0.73 (95% CI, 0.62–0.82; P = .0001).
- Fig 4.
An 88-year-old woman presented with left-sided weakness treated with intravenous rtPA without recanalization. A, Noncontrast head CT scan demonstrates loss of gray-white matter differentiation within the right frontal lobe and caudate body with an ASPECTS of 3 and a baseline NIHSS score of 17. B, Coronal MIP image demonstrates poor contrast opacification of right supra- and infraclinoid ICAs (arrowhead) and M1 segment extending into the proximal M2 branches (arrow), scoring a CBS of 1. C, Axial CTA source image demonstrates a CS of 1. The patient was not treated with thrombolysis, was not recanalized, and achieved an mRS score of 4 at 90 days.
Tables
Variable CBS (r) CS (r) ASPECTS 0.48 (P < .0001) 0.51 (P < .0001) Baseline NIHSS −0.34 (P = .002) −0.41 (P < .0001) Baseline CBF volume −0.44 (P < .0001) −0.54 (P < .0001) Baseline CBV volume −0.33 (P = .002) −0.56 (P < .0001) Baseline MTT volume −0.46 (P < .0001) −0.54 (P < .0001) 90-day mRS score −0.31 (P = .002) −0.43 (P = .0001) Final infarct volume −0.51 (P < .0001) −0.63 (P < .0001) Note:—CBS indicates clot burden score; CS, collateral score; ASPECTS, Alberta Stroke Program Early CT Score; NIHSS, National Institutes of Health Stroke Score; CBF, cerebral blood flow; CBV, cerebral blood volume; MTT, mean transit time; mRS, modified Rankin Scale.
- Table 2:
Patient clinical outcome dichotomized into good (mRS score, ≤2) and poor clinical outcome (mRS score, >2) at 90 days
Parameters mRS Score ≤2 (n = 38) mRS Score >2 (n = 47) P Value Age (yr), mean ± SD 65 (±15.7) 74 (±12.7) .0088 NCCT ASPECTS, median (IQR) 9 (7–9) 6 (4–7) <.0001 CBS, median (IQR) 7.5 (6–9) 6 (4–7) .0005 CS, median (IQR) 2.5 (2–3) 2 (1–2.5) .0015 Baseline NIHSS score, median (IQR) 11 (6–16) 19 (15–23) <.0001 rtPA, % (No.) 76.3 (29) 70.0 (31) .3447 rtPA dose (mg), mean ± SD 62.2 ± 14.0 59.2 ± 18.9 .9083 Time to scanning (min), median (IQR) 89 (65–120) 120 (80–150) .0267 Recanalization, % (No.) 57.9 (22) 31.9 (15) .0219 Final infarct size (cm3), mean ± SD 53 ± 72 172 ± 143 <.0001 Baseline CBF (cm3), mean ± SD 85 ± 41 110 ± 56 .0001 Baseline CBV (cm3), mean ± SD 22 ± 16 56 ± 45 .0001 Baseline MTT (cm3), mean ± SD 109 ± 84 84 ± 42 .0344 Note:—NCCT indicates noncontrast CT; IQR, interquartilerange; rtPA, recombinant tissue plasminogen activator.
- Table 3:
Univariate logistic regression analysis for favorable clinical outcome (mRS score, ≤2 at 90 days)
Parameter P Value OR Lower 95% Confidence Level for OR Upper 95% Confidence Level for OR Age .0151 0.956 0.922 0.991 ASPECTS <.0001 1.635 1.464 1.825 NIHSS score at presentation <.0001 0.827 0.755 0.904 rtPA given .3061 1.733 0.605 4.970 CBS <.0001 1.499 1.236 1.818 CS .0152 3.359 1.263 8.931 CBF .0263 0.989 0.980 0.999 MTT .0265 0.989 0.979 0.999 Time to rtPA .7977 0.998 0.984 1.013 rtPA dose .4959 1.011 0.979 1.045 CBS >6 .0033 4.219 1.617 11.010 Hyperglycemia .0303 0.097 0.012 0.801 Final infarct size .0002 0.442 0.286 0.684 Recanalization .0183 3.077 1.209 7.826 Note:—OR indicates odds ratio.
- Table 4:
Multivariate logistic regression analysis of favorable clinical outcome (mRS score, ≤2 at 90 days), controlling for confounders
Variable Coefficient P Value OR Lower CI of OR Upper CI of OR Intercept 0.4664 .8301 CBS 0.4448 .0089 1.560 1.118 2.177 Recanalization 1.6106 .0149 5.006 1.368 18.312 NIHSS score at presentation −0.1734 .0025 0.841 0.751 0.941 Age −0.0588 .0181 0.943 0.898 0.990 Parameter CBS ≤6 (n = 41) CBS >6 P Value Age, mean ± SD 68 (12) 71 (15) .18 ASPECTS, median (IQR) 6 (3.5–7.5) 9 (6–10) <.0001 Presenting NIHSS score, median (IQR) 18 (14.5–21) 13 (6.25–0.5) .009 Time to scanning (min), mean ± SD 122 ± 63 137 ± 20 .28 Time to rtPA (min), mean ± SD 142 ± 51 142 ± 26 .79 Post-rtPA recanalization (No.) (%) 14 (44%) 20 (71%) .04 Hyperglycemia (No.) (%) 6 (14.6%) 5 (11.4%) .75 Hypertension (No.) (%) 9 (22.0%) 13 (29.5%) .47 CS, median (IQR) 2 (1–2.5) 2.5 (2–3) .005 CBF (cm3), mean ± SD 119 ± 47 78 ± 51 <.0001 CBV (cm3), mean ± SD 49 ± 39 29 ± 35 .003 MTT (c cm3), mean ± SD 119 ± 43 76 ± 51 .0001 rtPA dose (mg), mean ± SD 61 ± 18 60 ± 14 0.21 Final infarct size (cm3), mean ± SD 179 ± 130 58 ± 98 <.0001 mRS, median (IQR) 4 (3–6) 2 (1–5) .002 Parenchymal hemorrhage (No.) (%) 10 (24) 4 (9) .05 Note:—ROC indicates receiver operating characteristic.
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