Tang Kun, Lin Kunxin, Lei Baoming, Li Jia, Liu Haifeng, Yang Yi, Liu Wenhua, Zhao Wenlong, Guo Zhangbao
Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China.
Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China.
Sci Rep. 2025 Sep 1;15(1):32136. doi: 10.1038/s41598-025-17792-7.
Thrombus enhancement sign (TES) is a potential imaging biomarker for differentiating embolic large vessel occlusion (embo-LVO) from intracranial atherosclerosis-related LVO (ICAS-LVO) in basilar artery occlusion (BAO). This study evaluates the association between TES and BAO etiology and its predictive value in distinguishing embo-LVO from ICAS-LVO. We conducted a prospective, two-center cohort study of acute ischemic stroke (AIS) patients with BAO who underwent EVT between January 2020 and September 2024. TES was assessed using thin-section maximum intensity projection (TS-MIP) CTA. Patients were classified as embo-LVO or ICAS-LVO based on post-EVT angiography. Logistic regression, receiver operator characteristic curve (ROC) and DeLong test were used to assess TES's diagnostic accuracy. Among 107 patients, TES was detected in 56.1% (60/107). TES was significantly more frequent in embo-LVO (85.2%) than in ICAS-LVO (17.4%) (p < 0.001). TES significantly associated with embo-LVO (OR, 16.136; 95% CI 4.672-55.733; p < 0.001). The area under the curve (AUC) of TES for embo-LVO was 0.839, outperforming distal BAO (AUC = 0.714, p = 0.02). Combining TES with distal BAO improved predictive accuracy (AUC = 0.883). TES is a reliable marker for identifying embo-LVO in BAO and enhancing endovascular treatment strategies for AIS.
血栓增强征（TES）是在基底动脉闭塞（BAO）中区分栓塞性大血管闭塞（embo-LVO）与颅内动脉粥样硬化相关的LVO（ICAS-LVO）的一种潜在影像学生物标志物。本研究评估了TES与BAO病因之间的关联及其在区分embo-LVO与ICAS-LVO中的预测价值。我们对2020年1月至2024年9月期间接受血管内治疗（EVT）的急性缺血性卒中（AIS）伴BAO患者进行了一项前瞻性、双中心队列研究。使用薄层最大密度投影（TS-MIP）CTA评估TES。根据EVT术后血管造影将患者分为embo-LVO或ICAS-LVO。采用逻辑回归、受试者操作特征曲线（ROC）和德龙检验来评估TES的诊断准确性。在107例患者中，56.1%（60/107）检测到TES。TES在embo-LVO中（85.2%）比在ICAS-LVO中（17.4%）明显更常见（p < 0.001）。TES与embo-LVO显著相关（OR，16.136；95% CI 4.672 - 55.733；p < 0.001）。TES对embo-LVO的曲线下面积（AUC）为0.839，优于远端BAO（AUC = 0.714，p = 0.02）。将TES与远端BAO相结合可提高预测准确性（AUC = 0.883）。TES是识别BAO中embo-LVO并优化AIS血管内治疗策略的可靠标志物。
