Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Room G1-240, Meibergdreef 9 1105 AZ, Amsterdam, The Netherlands.
Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Neuroradiology. 2022 Sep;64(9):1857-1867. doi: 10.1007/s00234-022-02971-4. Epub 2022 May 16.
We aimed to study the association of non-contrast CT (NCCT) thrombus density with procedural and clinical outcomes in patients with acute ischemic stroke who underwent endovascular treatment (EVT). Since thrombus density is associated with thrombus location, we focused on M1 occlusions only.
Patients with available thin-slice (< 2.5 mm) NCCT were included from a nationwide registry. Regression models were used to assess the relation between thrombus density (per Hounsfield unit [HU]) and the following outcomes. For reperfusion grade, adjusted common odds ratios (acOR) indicated a 1-step shift towards improved outcome per HU increase in thrombus density. For the binary outcomes of first-pass reperfusion (first-pass extended thrombolysis in cerebral infarction [eTICI] 2C-3, FPR), functional independence [90-day modified Rankin Scale (mRS) score of 0-2] and mortality), aORs were reported. Adjusted β coefficients (aβ) were reported for 24-h NIHSS and procedure duration in minutes. Outcome differences between first-line treatment devices (stent retriever versus aspiration) were assessed with interaction terms.
In 566 patients with M1 occlusions, thrombus density was not associated with reperfusion (acOR 1.01, 95% CI 0.99-1.02), FPR (aOR 1.01, 95% CI 0.99-1.03), mortality (aOR 0.98, 95% CI 0.95-1.00), 24-h NIHSS (aβ - 0.7%, 95% CI - 1.4-0.2), or procedure duration (aβ 0.27, 95% CI - 0.05-0.58). In multivariable analysis, thrombus density was associated with functional independence (aOR 1.02, 95% CI 1.00-1.05). No interaction was found between thrombus density and first-line treatment device for any outcome.
In patients with M1 occlusions, thrombus density was not clearly associated with procedural and clinical outcomes after EVT.
我们旨在研究急性缺血性脑卒中患者接受血管内治疗（EVT）后，非对比 CT（NCCT）血栓密度与手术和临床结局的关系。由于血栓密度与血栓位置相关，我们仅关注 M1 闭塞。
从一个全国性登记处纳入有可用薄层（<2.5mm）NCCT 的患者。使用回归模型评估血栓密度（每亨氏单位[HU]）与以下结果之间的关系。对于再灌注等级，调整后的常见比值比（acOR）表明，血栓密度每增加 1HU，再灌注结果改善 1 个等级。对于首次通过再灌注（首次通过扩展脑梗死溶栓[eTICI] 2C-3，FPR）、功能独立性（90 天改良 Rankin 量表[ mRS]评分 0-2）和死亡率的二分类结局，报告比值比（aOR）。报告 24 小时 NIHSS 和手术时间（分钟）的调整β系数（aβ）。通过交互项评估一线治疗设备（支架取栓与抽吸）之间的结局差异。
在 566 例 M1 闭塞患者中，血栓密度与再灌注（acOR 1.01，95%CI 0.99-1.02）、FPR（aOR 1.01，95%CI 0.99-1.03）、死亡率（aOR 0.98，95%CI 0.95-1.00）、24 小时 NIHSS（aβ-0.7%，95%CI-1.4-0.2）或手术时间（aβ 0.27，95%CI-0.05-0.58）无关。多变量分析中，血栓密度与功能独立性相关（aOR 1.02，95%CI 1.00-1.05）。在任何结局中，都未发现血栓密度与一线治疗设备之间存在交互作用。
在 M1 闭塞患者中，血栓密度与 EVT 后手术和临床结局之间无明显相关性。
