From the Department of Radiology and Nuclear Medicine (N.B., K.C.J.C., N.S., A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Department of Neurology (N.B., K.C.J.C., N.S., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Stroke. 2020 Jun;51(6):1727-1735. doi: 10.1161/STROKEAHA.119.027749. Epub 2020 May 14.
Background and Purpose- If a relationship between stroke etiology and thrombus computed tomography characteristics exists, assessing these characteristics in clinical practice could serve as a useful additional diagnostic tool for the identification of stroke subtype. Our purpose was to study the association of stroke etiology and thrombus computed tomography characteristics in patients with acute ischemic stroke due to a large vessel occlusion. Methods- For 1429 consecutive patients enrolled in the MR CLEAN Registry, we determined stroke cause as defined by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. The association of stroke etiology with the hyperdense artery sign, clot burden score, and thrombus location was estimated with univariable and multivariable binary and ordinal logistic regression. Additionally, for 367 patients with available thin-section imaging, we assessed the association of stroke etiology with absolute and relative thrombus attenuation, distance from internal carotid artery-terminus to thrombus, thrombus length, and thrombus attenuation increase with univariable and multivariable linear regression. Results- Compared with cardioembolic strokes, noncardioembolic strokes were associated with presence of hyperdense artery sign (odds ratio, 2.2 [95% CI, 1.6-3.0]), lower clot burden score (common odds ratio, 0.4 [95% CI, 0.3-0.6]), shift towards a more proximal thrombus location (common odds ratio, 0.2 [95% CI, 0.2-0.3]), higher absolute thrombus attenuation (β, 3.6 [95% CI, 0.9-6.4]), decrease in distance from the ICA-terminus (β, -5.7 [95% CI, -8.3 to -3.0]), and longer thrombi (β, 8.6 [95% CI, 6.5-10.7]), based on univariable analysis. Thrombus characteristics of strokes with undetermined cause were similar to those of cardioembolic strokes. Conclusions- Thrombus computed tomography characteristics of cardioembolic stroke are distinct from those of noncardioembolic stroke. Additionally, our study supports the general hypothesis that many cryptogenic strokes have a cardioembolic cause. Further research should focus on the use of thrombus computed tomography characteristics as a diagnostic tool for stroke cause in clinical practice.
如果血栓 CT 特征与卒中病因之间存在关联，那么在临床实践中评估这些特征可能成为识别卒中亚型的一种有用的附加诊断工具。我们的目的是研究大动脉闭塞性急性缺血性卒中患者的卒中病因与血栓 CT 特征之间的关联。方法：我们对 MR CLEAN 登记研究中的 1429 例连续患者，根据 TOAST（急性卒中治疗 ORG 10172 试验）标准确定卒中病因。采用单变量和多变量二项和有序逻辑回归估计卒中病因与高密度动脉征、血栓负荷评分和血栓位置之间的关系。此外，对于 367 例有薄层成像的患者，我们评估了卒中病因与绝对和相对血栓衰减、颈内动脉末端至血栓的距离、血栓长度和血栓衰减增加之间的关系，采用单变量和多变量线性回归。结果：与心源性栓塞性卒中相比，非心源性栓塞性卒中与高密度动脉征的存在相关（优势比，2.2[95%可信区间，1.6-3.0]）、血栓负荷评分较低（共同优势比，0.4[95%可信区间，0.3-0.6]）、血栓位置更向近端偏移（共同优势比，0.2[95%可信区间，0.2-0.3]）、绝对血栓衰减较高（β，3.6[95%可信区间，0.9-6.4]）、颈内动脉末端距离减小（β，-5.7[95%可信区间，-8.3 至-3.0]）和血栓更长（β，8.6[95%可信区间，6.5-10.7]），基于单变量分析。未确定病因的卒中的血栓特征与心源性栓塞性卒中相似。结论：心源性栓塞性卒中的血栓 CT 特征与非心源性栓塞性卒中不同。此外，我们的研究支持这样一个普遍假设，即许多隐源性卒中具有心源性病因。进一步的研究应集中于使用血栓 CT 特征作为临床实践中卒中病因的诊断工具。
