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European Radiology

, Volume 28, Issue 8, pp 3413–3421 | Cite as

Presence of multi-segment clot sign on dynamic CT angiography: a predictive imaging marker of recanalisation and good outcome in acute ischaemic stroke patients

  • Feina Shi
  • Zhicai Chen
  • Xiaoxian Gong
  • Meixia Zhang
  • David S. Liebeskind
  • Min Lou
Computed Tomography

Abstract

Objective

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).

Methods

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.

Results

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.

Conclusions

The MSC sign is a good indicator for recanalisation and good outcome after reperfusion therapy in anterior circulation LAO patients.

Key Points

• 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.

Keywords

Stroke Computed tomography angiography Biomarkers Brain infarction Prognosis 

Abbreviations

AIS

Acute ischaemic stroke

AOL

Arterial occlusive lesion

CTA

CT angiography

CTP

Perfusion CT

ECASS II

Second European-Australasian acute stroke study

HI

Haemorrhagic infarction

HT

Haemorrhagic transformation

LAO

Large artery occlusion

mRS

Modified Rankin scale

MSC sign

Multi-segment clot sign

NIHSS

National Institute of Health stroke scale

OIT

Onset-to-imaging time

ONT

Onset-to-needle time

PH

Parenchymal haemorrhage

RBC

Red blood cells

SWI

Susceptibility-weighted imaging

Notes

Funding

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

Guarantor

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.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

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.

Methodology

• retrospective

• observational study

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of NeurologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
  2. 2.UCLA Stroke CenterUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Zhejiang University Brain Research InstituteZhejiangChina

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