Presence of multi-segment clot sign on dynamic CT angiography: a predictive imaging marker of recanalisation and good outcome in acute ischaemic stroke patients
To investigate the value of multi-segment clot (MSC) sign on dynamic CT angiography (CTA) in predicting recanalisation and outcome after reperfusion therapy in acute ischaemic stroke (AIS) with large artery occlusion (LAO).
We retrospectively reviewed data of anterior circulation LAO patients from a prospectively collected database for consecutive AIS patients who underwent perfusion CT (CTP) before treatment. MSC sign was defined as the presence of multiple segments on dynamic CTA derived from CTP data. Good outcome was defined as modified Rankin score 0–3 at 90 days.
A total of 181 LAO patients were enrolled. MSC sign was present in 73 (40.3%) patients. When compared with patients without MSC sign, patients with MSC sign had a significantly higher rate of recanalisation (76.7% versus 56.5%, p = 0.005) and good outcome (67.1% versus 51.0%, p = 0.035). Multivariable logistic regression analyses showed that MSC sign was an independent predictor for both recanalisation (OR [95% CI] = 2.237 [1.069–4.681]; p = 0.033) and good outcome (OR [95% CI] = 2.715 [1.154–6.388]; p = 0.022) after adjustment.
The MSC sign is a good indicator for recanalisation and good outcome after reperfusion therapy in anterior circulation LAO patients.
• MSC sign was present in about 40% acute anterior circulation LAO patients.
• MSC sign is a predictor for recanalisation after reperfusion treatment.
• Patients with MSC sign have a better outcome.
KeywordsStroke Computed tomography angiography Biomarkers Brain infarction Prognosis
Acute ischaemic stroke
Arterial occlusive lesion
- ECASS II
Second European-Australasian acute stroke study
Large artery occlusion
Modified Rankin scale
- MSC sign
Multi-segment clot sign
National Institute of Health stroke scale
Red blood cells
This study has received funding by the National Natural Science Foundation of China (grant numbers 81622017, 81471170 and 81601017), Science Technology Department of Zhejiang Province (grant number 2017C04G1360592) and Natural Science Foundation of Zhejiang Province (grant number LQ16H090003).
Compliance with ethical standards
The scientific guarantor of this publication is Min Lou.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in Stroke, European Radiology and European Journal of Neurology.
• observational study
• performed at one institution
- 25.Tu HTH, Campbell BCV, Christensen S et al (2015) Worse stroke outcome in atrial fibrillation is explained by more severe hypoperfusion, infarct growth, and hemorrhagic transformation. Int J Stroke 10:534–540Google Scholar
- 30.Payabvash S, Benson JC, Tyan AE et al (2017) Multivariate prognostic model of acute stroke combining admission infarct location and symptom severity: a proof-of-concept study. J Stroke Cerebrovasc Dis. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.10.034