Evaluation of the clot burden score (CBS) for acute ischemic stroke (AIS) in intent-to-treat patients

  • Sarah Yaziz Department of Radiology, Hospital Kuala Lumpur
  • Ahmad Sobri Muda Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia.
  • Wan Asyraf Wan Zaidi Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre.
  • Nik Azuan Nik Ismail Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre.
Keywords: Acute ischemic stroke (AIS), Thrombus, Clot burden score (CBS), Modified Rankin scale (mRS), Receiver operating characteristics (ROC)

Abstract

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases.
Methods: A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves.
Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ≥6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%.
Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

Published
2019-12-31
How to Cite
Sarah Yaziz, Ahmad Sobri Muda, Wan Asyraf Wan Zaidi, & Nik Azuan Nik Ismail. (2019). Evaluation of the clot burden score (CBS) for acute ischemic stroke (AIS) in intent-to-treat patients. Cardiovascular, Neurovascular and Stroke, 1(1), 11-15. Retrieved from https://mycvns.com/index.php/cvns/article/view/6