RT Journal Article
SR Electronic
T1 CT Angiography Clot Burden Score and Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute Middle Cerebral Artery Infarct
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 525
OP 531
DO 10.3174/ajnr.A1408
VO 30
IS 3
A1 I.Y.L. Tan
A1 A.M. Demchuk
A1 J. Hopyan
A1 L. Zhang
A1 D. Gladstone
A1 K. Wong
A1 M. Martin
A1 S.P. Symons
A1 A.J. Fox
A1 R.I. Aviv
YR 2009
UL http://www.ajnr.org/content/30/3/525.abstract
AB BACKGROUND AND PURPOSE: Clot extent, location, and collateral integrity are important determinants of outcome in acute stroke. We hypothesized that a novel clot burden score (CBS) and collateral score (CS) are important determinants of clinical and radiologic outcomes and serve as useful additional stroke outcome predictors.MATERIALS AND METHODS: One hundred twenty-one patients with anterior circulation infarct presenting within 3 hours of stroke onset were reviewed. The Spearman correlation was performed to assess the correlation between CBS and CS and clinical and radiologic outcome measures. Patients were dichotomized by using a 90-day modified Rankin scale (mRS) score. Uni- and multivariate logistic regression models were used to assess variables predicting favorable clinical and radiologic outcomes. Receiver operating characteristic and intraclass correlation coefficient (ICC) analyses were performed. Diagnostic performance of a CBS threshold of >6 was assessed.RESULTS: There were 85 patients (mean age, 70 ± 14.5 years). Patients with higher CBS and CS demonstrated smaller pretreatment perfusion defects and final infarct volume and better clinical outcome (all, P < .01). CBS (P = .009) and recanalization (P = .015) independently predicted favorable outcome. A CBS >6 predicted good clinical outcome with an area under the curve of 0.75 (95% confidence interval [CI], 0.65–0.84; P = .0001), sensitivity of 73.0 (95% CI, 55.9–86.2), and specificity of 64.6 (95% CI, 49.5–77.8). The recanalization rate with intravenous recombinant tissue plasminogen activator was higher in patients with CBS >6 (P = .04; odds ratio, 3.2; 95% CI, 1.1–9.4). The ICC was 0.97 (95% CI, 0.95–0.98) and 0.87 (95% CI, 0.80–0.91) for CBS and CS, respectively.CONCLUSIONS: CBS and CS are useful additional markers predicting clinical and radiologic outcomes.