From the Department of Neuroradiology (I.D.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
Department of Neuroradiology (M.P., F.C.).
AJNR Am J Neuroradiol. 2021 Jan;42(1):42-48. doi: 10.3174/ajnr.A6865. Epub 2020 Nov 12.
Collateral status and thrombus length have been independently associated with functional outcome in patients with acute ischemic stroke. It has been suggested that thrombus length would influence functional outcome via interaction with the collateral circulation. We investigated the individual and combined effects of thrombus length assessed by the clot burden score and collateral status assessed by a FLAIR vascular hyperintensity-ASPECTS rating system on functional outcome (mRS).
Patients with anterior circulation acute ischemic stroke due to large-vessel occlusion from the ASTER and THRACE trials treated with endovascular thrombectomy were pooled. The clot burden score and FLAIR vascular hyperintensity score were determined on MR imaging obtained before endovascular thrombectomy. Favorable outcome was defined as an mRS score of 0-2 at 90 days. Association of the clot burden score and the FLAIR vascular hyperintensity score with favorable outcome (individual effect and interaction) was examined using logistic regression models.
Of the 326 patients treated by endovascular thrombectomy with both the clot burden score and FLAIR vascular hyperintensity assessment, favorable outcome was observed in 165 (51%). The rate of favorable outcome increased with clot burden score (smaller clots) and FLAIR vascular hyperintensity (better collaterals) values. The association between clot burden score and functional outcome was significantly modified by the FLAIR vascular hyperintensity score, and this association was stronger in patients with good collaterals, with an adjusted OR = 6.15 (95% CI, 1.03-36.81).
The association between the clot burden score and functional outcome varied for different collateral scores. The FLAIR vascular hyperintensity score might be a valuable prognostic factor, especially when contrast-based vascular imaging is not available.
在急性缺血性脑卒中患者中，侧支循环状态和血栓长度与功能结局独立相关。有人提出，血栓长度通过与侧支循环的相互作用影响功能结局。我们研究了通过血栓负荷评分评估的血栓长度和通过 FLAIR 血管高信号-ASPECTS 评分系统评估的侧支循环状态对功能结局（mRS）的单独和联合影响。
汇总了 ASTER 和 THRACE 试验中接受血管内血栓切除术治疗的因大血管闭塞引起的前循环急性缺血性脑卒中患者。在血管内血栓切除术前的 MR 成像上确定血栓负荷评分和 FLAIR 血管高信号评分。90 天时 mRS 评分为 0-2 定义为预后良好。使用逻辑回归模型检查血栓负荷评分和 FLAIR 血管高信号评分与预后良好（单独作用和相互作用）的关系。
在接受血管内血栓切除术治疗且均进行了血栓负荷评分和 FLAIR 血管高信号评估的 326 例患者中，165 例（51%）预后良好。随着血栓负荷评分（较小的血栓）和 FLAIR 血管高信号（更好的侧支循环）值的增加，预后良好的比例增加。血栓负荷评分与功能结局之间的关系显著受 FLAIR 血管高信号评分的影响，在侧支循环良好的患者中这种关系更强，调整后的 OR=6.15（95%CI，1.03-36.81）。
血栓负荷评分与功能结局之间的关系因不同的侧支循环评分而不同。FLAIR 血管高信号评分可能是一种有价值的预后因素，特别是在没有对比剂血管成像的情况下。
