Associations Between Collateral Status and Thrombus Characteristics and Their Impact in Anterior Circulation Stroke
Heitor Alves;Kilian Treurniet;Bruna Dutra;Ivo G. Jansen;Anna Boers;Emilie Santos;Olvert Berkhemer;Diederik Dippel;Aad van der Lugt;Wim van Zwam;Robert van Oostenbrugge;Hester Lingsma;Yvo Roos;Albert Yoo;Henk Marquering;Charles Majoie;
From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands.
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Background and Purpose—Thrombus characteristics and collateral score are associated with functional outcome in patients with acute ischemic stroke. It has been suggested that they affect each other. The aim of this study is to evaluate the association between clot burden score, thrombus perviousness, and collateral score and to determine whether collateral score influences the association of thrombus characteristics with functional outcome.Methods—Patients with baseline thin-slice noncontrast computed tomography and computed tomographic angiography images from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands) were included (n=195). Collateral score and clot burden scores were determined on baseline computed tomographic angiography. Thrombus attenuation increase was determined by comparing thrombus density on noncontrast computed tomography and computed tomographic angiography using a semiautomated method. The association of collateral score with clot burden score and thrombus attenuation increase was evaluated with linear regression. Mediation and effect modification analyses were used to assess the influence of collateral score on the association of clot burden score and thrombus attenuation increase with functional outcome.Results—A higher clot burden score (B=0.063; 95% confidence interval, 0.008–0.118) and a higher thrombus attenuation increase (B=0.014; 95% confidence interval, 0.003–0.026) were associated with higher collateral score. Collateral score mediated the association of clot burden score with functional outcome. The association between thrombus attenuation increase and functional outcome was modified by the collateral score, and this association was stronger in patients with moderate and good collaterals.Conclusions—Patients with lower thrombus burden and higher thrombus perviousness scores had higher collateral score. The positive effect of thrombus perviousness on clinical outcome was only present in patients with moderate and high collateral scores.Clinical Trial Registration—URL: http://www.trialregister.nl. Unique identifier: NTR1804 and URL: http://www.controlled-trials.com Unique identifier: ISRCTN10888758.