Abstract WP80: Thrombus Imaging Characteristics and Association With Functional Outcomes in Patients Undergoing Endovascular Treatment

Abstract

Background: Intracranial thrombus characteristics on computed tomography angiography (CTA) in patients undergoing endovascular therapy (ET) for anterior circulation large vessel occlusion (LVO) acute ischemic stroke (AIS) has been shown to be useful in prognosticating functional outcomes. We establish if thrombus characteristics on non-contrast computed tomography (CT) scans and CTA were associated with clinical outcomes. Methods: We included 257 patients with anterior circulation LVO AIS from our Hyper-Acute Stroke Thrombolysis and Endovascular (HASTEN) registry treated at our tertiary academic institution from 2014-2018. We evaluated associations of patient’s characteristics and thrombus imaging characteristics with patients’ functional outcomes, scored with the modified Rankin Scale (MRS) at 3 months. Imaging characteristics were assessed on CT and CTA. Patient characteristics included age, presence of co-morbidities, initial NIHSS and ASPECTS. Thrombus characteristics included presence of hyperdense middle cerebral artery (MCA) sign, CT dense MCA length, CTA location and length of thrombus, CTA clot burden score (CBS) and recanalization status (mTICI). A good functional outcome was defined as patients who achieved an MRS of 0-2 at 3 months. Results: Patient characteristics associated with good functional outcomes were younger age, absence of diabetes mellitus, lower NIHSS, higher ASPECTS and successful recanalization measured by a mTICI 2b/3 (Table 1). Thrombus characteristics associated with good functional outcomes were a shorter CT dense MCA length and a higher CTA CBS (Table 1). Of note, presence of a hyperdense MCA sign on CT and CTA thrombus length were not significantly associated with good functional outcomes. Conclusions: In patients with anterior circulation LVO AIS, a shorter CT dense MCA length and a higher CTA CBS were associated with good functional outcomes, and may aid in improving patient selection.