Does Clot Burden Score on Baseline T2*-MRI Impact Clinical Outcome in Acute Ischemic Stroke Treated with Mechanical Thrombectomy?
- Author:
Imad DERRAZ
1
;
Romain BOURCIER
;
Marc SOUDANT
;
Sébastien SOIZE
;
Wagih Ben HASSEN
;
Gabriella HOSSU
;
Frederic CLARENCON
;
Anne Laure DERELLE
;
Marie TISSERAND
;
Helene RAOULT
;
Laurence LEGRAND
;
Serge BRACARD
;
Catherine OPPENHEIM
;
Olivier NAGGARA
Author Information
- Publication Type:Original Article
- Keywords: Ischemic stroke; Magnetic resonance imaging; Thrombosis; Endovascular recanalization
- MeSH: Humans; Magnetic Resonance Imaging; Odds Ratio; Stroke; Thrombectomy; Thrombosis
- From:Journal of Stroke 2019;21(1):91-100
- CountryRepublic of Korea
- Language:English
- 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.
