From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands.
Stroke. 2018 Feb;49(2):391-396. doi: 10.1161/STROKEAHA.117.019509. Epub 2018 Jan 10.
Thrombus characteristics and collateral score are associated with functional outcome in patients with acute ischemic stroke. It has been suggested that they affect each other. The aim of this study is to evaluate the association between clot burden score, thrombus perviousness, and collateral score and to determine whether collateral score influences the association of thrombus characteristics with functional outcome.
Patients with baseline thin-slice noncontrast computed tomography and computed tomographic angiography images from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands) were included (n=195). Collateral score and clot burden scores were determined on baseline computed tomographic angiography. Thrombus attenuation increase was determined by comparing thrombus density on noncontrast computed tomography and computed tomographic angiography using a semiautomated method. The association of collateral score with clot burden score and thrombus attenuation increase was evaluated with linear regression. Mediation and effect modification analyses were used to assess the influence of collateral score on the association of clot burden score and thrombus attenuation increase with functional outcome.
A higher clot burden score (B=0.063; 95% confidence interval, 0.008-0.118) and a higher thrombus attenuation increase (B=0.014; 95% confidence interval, 0.003-0.026) were associated with higher collateral score. Collateral score mediated the association of clot burden score with functional outcome. The association between thrombus attenuation increase and functional outcome was modified by the collateral score, and this association was stronger in patients with moderate and good collaterals.
Patients with lower thrombus burden and higher thrombus perviousness scores had higher collateral score. The positive effect of thrombus perviousness on clinical outcome was only present in patients with moderate and high collateral scores.
URL: http://www.trialregister.nl. Unique identifier: NTR1804 and URL: http://www.controlled-trials.com Unique identifier: ISRCTN10888758.
血栓特征和侧支循环评分与急性缺血性脑卒中患者的功能结局相关。有人提出，它们相互影响。本研究旨在评估血栓负荷评分、血栓通透性和侧支循环评分之间的相关性，并确定侧支循环评分是否影响血栓特征与功能结局之间的相关性。
纳入 MR CLEAN 试验（荷兰多中心急性缺血性脑卒中血管内治疗随机临床试验）中基线薄层非对比 CT 和 CT 血管造影图像的患者（n=195）。在基线 CT 血管造影上确定侧支循环评分和血栓负荷评分。通过使用半自动方法比较非对比 CT 和 CT 血管造影上的血栓密度，确定血栓衰减增加。使用线性回归评估侧支循环评分与血栓负荷评分和血栓衰减增加的相关性。采用中介和效应修饰分析评估侧支循环评分对血栓负荷评分和血栓衰减增加与功能结局相关性的影响。
更高的血栓负荷评分（B=0.063；95%置信区间，0.008-0.118）和更高的血栓衰减增加（B=0.014；95%置信区间，0.003-0.026）与更高的侧支循环评分相关。侧支循环评分介导了血栓负荷评分与功能结局的相关性。血栓衰减增加与功能结局的相关性受侧支循环评分的修饰，在中、高侧支循环评分的患者中，这种相关性更强。
血栓负荷评分较低和血栓通透性评分较高的患者侧支循环评分较高。血栓通透性对临床结局的积极影响仅存在于中、高侧支循环评分的患者中。
网址：http://www.trialregister.nl。唯一标识符：NTR1804 和网址：http://www.controlled-trials.com。唯一标识符：ISRCTN10888758。
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