Analysis of the baseline multiphase computed tomographic angiography findings to predict clinical outcomes in patients with middle cerebral artery M1 occlusion treated with mechanical thrombectomy

PURPOSE: We aimed to evaluate the predictive ability of baseline multiphase computed tomographic angiography (mCTA) findings and the time from symptom onset to imaging in predicting functional outcomes in patients with middle cerebral artery (MCA) M1 occlusion treated with mechanical thrombectomy (MT).
METHODS: A total of 70 patients were evaluated retrospectively. The time between the onset of symptoms and imaging, thrombus density, estimated thrombus length, the Alberta Stroke Program Early CT Score (ASPECTS) on non-contrast CT, collateral circulation (CC), actual thrombus length, and clot burden score were assessed on mCTA images. Patients with a 90-day modified Rankin scale score of 0–2 were categorized as having good outcomes, whereas the others were categorized as having poor outcomes. The mCTA findings of patients with good and poor outcomes were compared, and binary logistic regression analysis was performed to identify independent predictors that could affect clinical outcomes.
RESULTS: The estimated thrombus length, the ASPECTS, thrombus density, clot burden score, and CC grade were not significantly different between patients with good and poor outcomes. The actual thrombus length was shorter in patients with good outcomes than in those with poor outcomes (15.9 mm versus 21.5 mm, P = 0.001). Binary logistic regression analysis revealed that actual thrombus length [P = 0.005, odds ratio (OR): 0.754, 95% confidence interval (CI): 0.61–0.92] and thrombus density (P = 0.022, OR: 1.167, 95% CI: 1.02–1.33) were independent variables for a good outcome. The optimal cut-off value for actual thrombus length was 18.7 mm (area under the curve, 0.74; 95% CI: 0.62–0.86; P = 0.001) to predict good outcomes.
CONCLUSION: Higher thrombus density and actual thrombus length shorter than 18.7 mm were associated with good clinical outcomes. However, no significant correlation was found between clinical outcomes and the ASPECTS, CC degree, or clot burden scores.
CLINICAL SIGNIFICANCE: Thrombus length and density are associated with the clinical outcome of patients with MCA M1 occlusion treated with MT who have distal collateral filling sufficient to depict thrombus margins in mCTA.