Clot Burden Score (CBS)

Created 22/03/2021, last revision 20/09/2023

  • the extent of intracranial thrombosis predicts clinical outcome, final infarct size, and risk of hemorrhagic transformation in acute ischemic stroke
    • clots with proximal localization and increased length are more difficult to treat and have a worse outcome
  • Clot Burden Score (CBS) is a semiquantitative, CTA-based score that defines the extent of thrombosis in the anterior circulation 
  • 10 points are assigned for a normal CTA
    • 2 points are subtracted for thrombus in the proximal M1, distal M1, or supraclinoid ICA portion
    • 1 point is subtracted for thrombus in M2 branches, A1, and/or infraclinoid ICA portion
  • the recanalization rate is higher with intravenous tPA  in patients with a CBS > 6   [Demchuk, 2009]
  • a lower CBS is associated with lower follow-up ASPECTS and higher rates of parenchymal hematoma  [Puetz, 2008]
  • CBS <10 was associated with decreased 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 also be assessed on MRA or MR-GRE (T2*CBSCBS 9 on MR GRE  [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 scale (CBS)
Clot Burden Score - CBS (Tan, AJNR 2009)
T-occlusion (ICA, MCA, ACA) - Clot Burden Score 5

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Clot Burden Score (CBS)