From the Department of Neurology (Z.C., F.S., M.Z., X.G., M.L.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
School of Medicine and Public Health (L.L.), University of Newcastle, New South Wales, Australia.
AJNR Am J Neuroradiol. 2018 Apr;39(4):663-668. doi: 10.3174/ajnr.A5549. Epub 2018 Feb 15.
The multisegment clot sign has been observed at the site of large-artery occlusion in patients with acute ischemic stroke. This study aimed to assess its occurrence rate and relationship with stroke etiologies in patients with acute intracranial large-artery occlusion.
We included consecutive patients with acute ischemic stroke who had acute intracranial large-artery occlusion and underwent perfusion CT within 8 hours after stroke onset. The multisegment clot sign was assessed on dynamic CT angiography derived from perfusion CT. The stroke etiologies were defined by the international Trial of Org 10172 in Acute Stroke Treatment criteria. Poisson regression analyses and diagnostic testing were used to investigate the relationship between the multisegment clot sign and stroke etiologies.
Finally, 194 patients with intracranial large-artery occlusion were enrolled. According to the Trial of Org 10172 in Acute Stroke Treatment criteria, 110 (56.7%) patients were diagnosed with cardioembolism; 43 (22.2%), with large-artery atherosclerosis; and 41 (21.1%), with undetermined etiology. The multisegment clot sign was found in 74 (38%) patients. Poisson regression analysis showed that the presence of the multisegment clot sign was significantly higher in patients with cardioembolism than in those with large-artery atherosclerosis (52.7% versus 9.3%; prevalence ratio, 1.53; 95% confidence interval, 1.03-2.90; = .037). For determined etiologies, the sensitivity, specificity, and positive and negative predictive values of the multisegment clot sign for predicting cardioembolism were 52.7%, 90.7%, 93.5%, and 42.9%, respectively.
The presence of the multisegment clot sign on dynamic CTA specifically indicates intracranial large-artery occlusion caused by an embolism from a cardiac source, which may be useful for acute management and secondary prevention of stroke.
在急性缺血性脑卒中患者的大动脉闭塞部位观察到多节段血栓征。本研究旨在评估其在急性颅内大动脉闭塞患者中的发生率及其与卒中病因的关系。
我们纳入了连续的急性缺血性脑卒中患者，这些患者在卒中发病后 8 小时内行灌注 CT 检查，并在 CT 血管造影上观察到多节段血栓征。卒中病因采用国际组织 10172 急性卒中治疗试验标准进行定义。采用泊松回归分析和诊断性检测来研究多节段血栓征与卒中病因之间的关系。
最终纳入 194 例颅内大动脉闭塞患者。根据国际组织 10172 急性卒中治疗试验标准，110 例（56.7%）患者诊断为心源性栓塞；43 例（22.2%）为大动脉粥样硬化；41 例（21.1%）为病因不明。74 例（38%）患者发现有多节段血栓征。泊松回归分析显示，心源性栓塞患者多节段血栓征的发生率明显高于大动脉粥样硬化患者（52.7%比 9.3%；患病率比，1.53；95%置信区间，1.03-2.90；P=0.037）。对于确定病因，多节段血栓征预测心源性栓塞的敏感性、特异性、阳性预测值和阴性预测值分别为 52.7%、90.7%、93.5%和 42.9%。
动态 CTA 上多节段血栓征的存在提示颅内大动脉闭塞是由心源性来源的栓塞引起的，这可能有助于急性处理和卒中的二级预防。
