Clot Burden and Collaterals in Anterior Circulation Stroke: Differences Between Single-Phase CTA and Multi-phase 4D-CTA

Kaschka, Iris; Kloska, Stephan P.; Struffert, Tobias; Engelhorn, Tobias; Gölitz, Philipp; Kurka, Natalia; Köhrmann, Martin; Schwab, Stefan; Doerfler, Arnd

doi:10.1007/s00062-014-0359-6

Cited by 35 publications

(28 citation statements)

References 19 publications

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“…Multiphase four-dimensional CTA (4D-CTA) provides a more accurate assessment of intracranial thrombi than single-phase CTA 15 16. 4D-CTA was not included in the SWIFT PRIME protocol, and thus we were unable to study whether CBS measured with 4D-CTA would have had a different predictive value on the efficacy of Solitaire stent retriever thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy: analysis of the SWIFT PRIME trial

Mokin

Levy

Siddiqui

et al. 2016

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 99%

Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy: analysis of the SWIFT PRIME trial

Mokin

Levy

Siddiqui

et al. 2016

J NeuroIntervent Surg

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“…In addition, CTA can overestimate the extent of thrombus involvement if the collateral circulation is weak or if not enough time has elapsed between contrast injection and brain imaging, such that contrast does not reach the distal end of the thrombus. [25][26][27] However, this lack of collateral filling on conventional CTA might add to the prognostic strength of the CBS as poor collaterals result in lower CBS. 27 Furthermore, similar correlations between CBS and mRS at 3 months were found for 4D-CTA and conventional CTA.…”

Section: December 2016mentioning

confidence: 99%

“…27 Furthermore, similar correlations between CBS and mRS at 3 months were found for 4D-CTA and conventional CTA. 26 The imaging protocols utilized at the enrolling centers in MR CLEAN reflect the real-world variability in the current clinical practice. Future studies should examine the impact of collateral strength and imaging acquisition timing on the CBS variability and the association of CBS with neurological outcome.…”

Section: December 2016mentioning

confidence: 99%

Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke

Treurniet¹,

Yoo²,

Berkhemer

et al. 2016

Stroke

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R ecanalization of the occluded vessel is the major focus of modern treatment for acute ischemic stroke. With the accumulating evidence of the additional benefit of intra-arterial treatment (IAT) in patients with anterior circulation acute ischemic stroke, a new era has started in stroke management. [1][2][3][4][5] However, even after IAT, up to 67% of patients with acute Background and Purpose-A high clot burden score (CBS) is associated with favorable outcome after intravenous treatment for acute ischemic stroke. The added benefit of intra-arterial treatment might be less in these patients. The aim of this exploratory post hoc analysis was to assess the relation of CBS with neurological improvement and endovascular treatment effect. Methods-For 499 of 500 patients in the MR CLEAN study (Multicenter Randomized Clinical Trial of EndovascularTreatment for Acute Ischemic Stroke in the Netherlands), the CBS was determined. Ordinal logistic regression models with and without main baseline prognostic variables were used to assess the association between CBS (continuous or dichotomized at CBS of 6) and a shift toward better outcome on the modified Rankin Scale. The model without main baseline prognostic variables only included treatment allocation and CBS. Models with and without a multiplicative interaction term of CBS and treatment were compared using the χ 2 test to assess treatment effect modification by CBS. Results-Higher CBS was associated with a shift toward better outcome on the modified Rankin Scale; adjusted common odds ratio per point CBS was 1.12 (95% confidence interval, 1.04-1.20]. Dichotomized CBS had an adjusted common odds ratio of 1.67 (95% confidence interval, 1.12-2.51). Both effect estimates were slightly attenuated by adding baseline prognostic variables. The addition of the interaction terms did not significantly improve the fit of the models. There was a small and insignificant increase of intra-arterial treatment efficacy in the high CBS group. Conclusions-A higher CBS is associated with improved outcome and may be used as a prognostic marker. We found no evidence that CBS modifies the effect of intra-arterial treatment. Clinical Trial Registration-URL: http://www.trialregister.nl. Unique identifier: NTR1804. URL: http://www.controlledtrials.com. Unique identifier: ISRCTN10888758.

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“…With the advent of CT scanners allowing volumetric perfusion CT examinations of almost the entire brain, time-resolved 4-dimensional CT angiography (4D CTA) of the cerebral vasculature can be obtained in the same setting from the same data, to noninvasively study cerebral hemodynamics. Thus, occlusion of intracranial vessels, thrombus burden, and collateral blood flow can be visualized from the same VPCT source data that are used for perfusion parameter map analysis [11][12][13][14].…”

Section: Theory Of Ct-perfusionmentioning

confidence: 99%

An Appeal to Standardize CT- and MR-Perfusion

Turowski

Schramm

2015

Clin Neuroradiol

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Multiple treatment options and risk assessment in cerebrovascular diseases are the actual challenges in diagnostic as well as in interventional neuroradiology.Acute ischemic stroke essentially requires rapid detection of the location and extent of infarction and tissue at risk for making treatment decisions. In the acute setting, modern multiparametric perfusion imaging protocols help to determine infarct core and adjacent penumbral tissue, and they enable the estimation of collateral flow of intra- and extracranial arteries. In subacute delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) or chronic occlusive neurovascular diseases estimation of residual and collateral flow may be even more difficult.Prediction of sufficient or insufficient supply of brain tissue may be essential to balance conservative against interventional therapies. However, so far no established reliable thresholds are available for determining tissue at acute, subacute, chronic progressive, or chronic risk.Reliable and reproducible thresholds require quantitative perfusion measurements with a calibrated instrument. But the measurement instrument is not at all defined-a variety of parameter settings, different algorithms based on multiple assumptions and a wide variety of published normal and pathologic values for perfusion parameters indicate the problem. In the following text, we explain how deep the problem may be enrooted within techniques and algorithms impeding broad use of perfusion for many clinical issues.

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Clot Burden and Collaterals in Anterior Circulation Stroke: Differences Between Single-Phase CTA and Multi-phase 4D-CTA

Abstract: 4D-CTA more closely defines clot burden and collateral supply in anterior circulation stroke than CTA, implicating an additional diagnostic benefit.

Cited by 35 publications

References 19 publications

Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy: analysis of the SWIFT PRIME trial

Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy: analysis of the SWIFT PRIME trial

Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke

An Appeal to Standardize CT- and MR-Perfusion

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