Association of thrombus enhancement with mortality following endovascular therapy in patients with acute anterior circulation stroke

Thrombus enhancement sign (TES) has emerged as a potential imaging biomarker in patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT). To evaluate the prognostic value of TES on 90-day mortality and functional outcomes. We conducted a prospective, two-center study involving 323 patients with AIS treated with EVT. TES was assessed by CT angiography (CTA) using thin-slab maximum intensity projection. The primary outcome was 90-day mortality; secondary outcomes included functional outcomes measured by the modified Rankin Scale (mRS). Subgroup, mediation, and sensitivity analyses were conducted to assess the predictive value of TES across different clinical factors. TES positivity was identified in 228 (70.6%) patients. TES-positive patients had a 90-day mortality rate of 25.0%, compared with 9.5% in TES-negative patients. TES was significantly associated with 90-day mortality in both univariate analysis (OR=4.275, 95% CI 1.765 to 10.350, P=0.001) and multivariate model 3 (adjusted OR=3.821, 95% CI 1.449 to 10.075, P=0.007). TES was also associated with 90-day mRS score 0-2 (OR=0.500, 95% CI 0.305 to 0.819, P=0.006) in univariate analysis. TES is an independent predictor of 90-day mortality and poor functional outcomes in patients with AIS treated with EVT. TES can potentially serve as a valuable imaging biomarker for identifying high-risk patients.