ADD-ONS / SCALES

Clot Burden Score (CBS)

 Created 02.08.2020 , last update 22.03.2021

  • the extent of intracranial thrombosis predicts clinical outcome, final infarct size, and risk of hemorrhagic transformation in an acute ischemic stroke
    • proximal position and increased clot length is harder to treat, leading to a worse outcome
  • Clot Burden Score (CBS) is a semiquantitative CTA-based assessment score defining the extent of thrombosis in the anterior circulation 
  • 10 points are assigned to normal CTA
    • 2 points each are subtracted for thrombus in the proximal M1, distal M1, or supraclinoid ICA
    • 1 point is subtracted for thrombus in M2 branches, A1 and/or infraclinoid ICA
  • the recanalization rate with intravenous tPA is higher in patients with CBS > 6   [Demchuk, 2009]
  • lower CBS is associated with lower follow-up ASPECTS and higher parenchymal hematoma rates  [Puetz, 2008]
  • CBS <10 was associated with reduced odds of favorable functional outcome
    • odds ratio 0.09 for CBS ≤ 5, 0.22 for CBS 6-7 and 0.48 for CBS 8-9
  • CBS can be assessed on MRA or MR-GRE as well (T2*CBSCBS 9 on GRE (Derraz, 2019)  [Derraz, 2019]
infraclinoid portion of ICA – 1
supraclinoid portion of ICA
– 2
proximal M1 segment
– 2
distal M1 segment
– 2
M2 branch
– 1
M2 branch
– 1
ACA – 1
Clot burden score (CBS) - 10 points are assigned to normal CTA
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