Presence of multi-segment clot sign on dynamic CT angiography: a predictive imaging marker of recanalisation and good outcome in acute ischaemic stroke patients.

OBJECTIVE

To investigate the value of multi-segment clot (MSC) sign on dynamic CT angiography (CTA) in predicting recanalisation and outcome after reperfusion therapy in acute ischaemic stroke (AIS) with large artery occlusion (LAO).

METHODS

We retrospectively reviewed data of anterior circulation LAO patients from a prospectively collected database for consecutive AIS patients who underwent perfusion CT (CTP) before treatment. MSC sign was defined as the presence of multiple segments on dynamic CTA derived from CTP data. Good outcome was defined as modified Rankin score 0-3 at 90 days.

RESULTS

A total of 181 LAO patients were enrolled. MSC sign was present in 73 (40.3%) patients. When compared with patients without MSC sign, patients with MSC sign had a significantly higher rate of recanalisation (76.7% versus 56.5%, p = 0.005) and good outcome (67.1% versus 51.0%, p = 0.035). Multivariable logistic regression analyses showed that MSC sign was an independent predictor for both recanalisation (OR [95% CI] = 2.237 [1.069-4.681]; p = 0.033) and good outcome (OR [95% CI] = 2.715 [1.154-6.388]; p = 0.022) after adjustment.

CONCLUSIONS

The MSC sign is a good indicator for recanalisation and good outcome after reperfusion therapy in anterior circulation LAO patients.

KEY POINTS

• MSC sign was present in about 40% acute anterior circulation LAO patients. • MSC sign is a predictor for recanalisation after reperfusion treatment. • Patients with MSC sign have a better outcome.