Influence of the “distance to thrombus” in acute middle cerebral artery occlusion: A predictor for the clinical outcome after endovascular treatment

Abstract

Background: The therapy strategy of patients with acute stroke of the middle cerebral artery (MCA) is influenced by the location of the occlusion. The purpose of this study was to analyze the clinical outcome in patients with acute ischemic MCA occlusion according to the location of occlusion who underwent endovascular treatment (EVT). Methods: A total of 54 patients (age 73 ± 15 years; 59% female) with acute ACM occlusion treated with EVT were included. In coronary reformatted CT angiography images, the distance to the thrombus (DT), i.e. the distance from the carotid T to the beginning of the thrombus, was measured. Correlations between DT, clinical symptoms, and clinical outcome of patients who underwent EVT were analyzed. Results: DT correlated with clinical symptoms measured by the National Institutes of Health Stroke Scale (NIHSS; p = 0.017; R = −0.324) at baseline. DT also correlated with the modified Rankin scale after 90 days (90-day mRS; p = 0.014; R = −0.333). DT was a predictor for a good clinical outcome (mRS after 90 days) after EVT; odds ratio 1.113 (P = 0.02; 95% confidence interval [CI] 1.017–1.219). A DT >10 mm correlated significantly (p = 0.036) with a good clinical outcome (90-day mRS ≤2). Conclusion: DT correlates with the clinical symptoms of patients with acute MCA occlusion. In addition, DT is an independent predictor of the clinical outcome of patients suffering from acute stroke due to MCA occlusion.