Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Eur Stroke J. 2024 Dec;9(4):1025-1033. doi: 10.1177/23969873241256251. Epub 2024 Jun 6.
Thrombus enhancement sign (TES) is associated with cardioembolic stroke and first-pass angiographic failure in anterior ischemic stroke. However, the relationship between TES and stroke subtype and recanalization status after endovascular treatment (EVT) in basilar artery occlusion (BAO) remains unknown.
This retrospective study included consecutive patients with acute BAO who underwent EVT between January 2020 and September 2023. Each patient underwent baseline non-contrast computed tomography (CT) and CT angiography. Two independent readers assessed the presence of TES. Stroke types were classified according to the Trial of ORG 10172 for Acute Stroke Treatment. Successful recanalization was defined as a modified Thrombolysis in Cerebral Infarction score of 2b-3 after EVT. Clinical and interventional parameters, along with histopathological thrombi examination results, were compared between the TES-positive and TES-negative groups. The associations between TES and stroke subtype and recanalization status were analyzed using univariate and multivariate analyses.
A total of 151 patients were included in the analysis, among whom 116 (77%) exhibited TES. TES showed a significant correlation with cardioembolic and cryptogenic strokes (odds ratio [OR]: 8.56; 95% confidence interval: 3.49-22.4; < 0.001), whereas the TES-positive thrombi were characterized by a higher fibrin/platelet proportion ( = 0.002) and lower erythrocyte proportion ( = 0.044). The TES-positive group demonstrated favorable outcomes compared to the TES-negative group, including a shorter procedure time ( < 0.001), lower number of thrombectomy attempts ( = 0.010), higher incidence of first pass success ( = 0.022), and lower rate of requiring rescue angioplasty and/or stenting ( < 0.001). In multivariate analysis, TES remained independently associated with successful recanalization (OR: 9.63; 95% CI: 2.33, 47.7; = 0.003) after adjusting for baseline confounders.
Visualization of TES serves as a reliable and easily accessible marker for identifying cardioembolic and cryptogenic strokes and predicting recanalization success in thrombectomy for basilar artery occlusion.
血栓增强征（TES）与心源性栓塞性卒中及前循环缺血性卒中首次通过血管造影失败相关。然而，在基底动脉闭塞（BAO）的血管内治疗（EVT）后，TES 与卒中和再通状态之间的关系尚不清楚。
本回顾性研究纳入了 2020 年 1 月至 2023 年 9 月期间接受 EVT 的急性 BAO 连续患者。每位患者均进行了基线非对比 CT（NCCT）和 CT 血管造影。两名独立的读者评估 TES 的存在情况。根据急性卒中治疗的 ORG 10172 试验对卒中类型进行分类。EVT 后改良脑梗死溶栓评分（mTICI）2b-3 定义为再通成功。比较 TES 阳性组和 TES 阴性组的临床和介入参数以及组织病理学血栓检查结果。使用单变量和多变量分析评估 TES 与卒中类型和再通状态之间的关系。
共有 151 名患者纳入分析，其中 116 名（77%）表现出 TES。TES 与心源性和隐源性卒中有显著相关性（比值比 [OR]：8.56；95%置信区间：3.49-22.4； < 0.001），而 TES 阳性血栓的纤维蛋白/血小板比例较高（ = 0.002），红细胞比例较低（ = 0.044）。与 TES 阴性组相比，TES 阳性组的预后更好，包括手术时间更短（ < 0.001）、取栓次数更少（ = 0.010）、首次通过成功率更高（ = 0.022）以及需要补救性血管成形术和/或支架置入术的比例更低（ < 0.001）。多变量分析表明，在校正基线混杂因素后，TES 仍然与再通成功独立相关（OR：9.63；95%CI：2.33，47.7； = 0.003）。
TES 的可视化可作为一种可靠且易于获取的标志物，用于识别心源性和隐源性卒中和预测基底动脉闭塞取栓的再通成功率。
