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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Prognostic value of the modified clot burden score in predicting outcomes of acute ischemic stroke patients

Kaveh Bahrami¹, Mohsen Soltani Sabi¹, Payam Sasannejad¹

¹Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

|February 1, 2026

Insights

The modified Clot Burden Score (mCBS) better predicts outcomes like disability and severity in acute stroke patients than the original CBS. This modified scoring system shows promise as a potential replacement for the conventional CBS.

Area of Science:

Neurology
Medical Imaging
Clinical Prognostics

Background:

Acute stroke remains a leading global cause of mortality and disability.
Predictive scoring systems are crucial for managing acute stroke patients.
The Clot Burden Score (CBS) is one such system used to assess stroke severity and prognosis.

Purpose of the Study:

To evaluate the prognostic value of a modified Clot Burden Score (mCBS) in acute ischemic stroke patients.
To compare the predictive accuracy of mCBS against the original CBS for various stroke outcomes.
To determine if mCBS offers improved prediction for mortality, disability, and disease severity.

Main Methods:

A cohort of 130 acute ischemic stroke patients was studied between 2022 and 2024.
Clinical data including NIHSS, ASPECTS, and modified Rankin Scale (mRS) at admission and 90 days were collected.
The prognostic value of both original CBS and modified CBS (mCBS) was assessed using statistical analysis, focusing on predicting mortality, disability (mRS≥2), and severity (NIHSS≥15).

Main Results:

The modified CBS (mCBS) demonstrated stronger correlations with NIHSS and 90-day mRS compared to the original CBS.
mCBS showed significantly higher predictive accuracy (AUC) for disability (0.807 vs. 0.735) and severity (0.778 vs. 0.720) than CBS.
While mCBS showed a trend towards better mortality prediction, the difference was not statistically significant.

Conclusions:

The modified CBS exhibits superior prognostic value over the conventional CBS in predicting outcomes for acute stroke patients.
mCBS demonstrates enhanced ability to predict disability and stroke severity.
Further research validating these findings could support the adoption of mCBS as a replacement for the current CBS scoring system.

Read full analysis

Abstract

Background:

Acute stroke is one of the leading causes of mortality and disability worldwide. In recent years, various scoring systems have been introduced to predict the outcomes of acute stroke patients, one of which is the Clot Burden Score (CBS). Therefore, the present study evaluates the prognostic value of the modified CBS in patients presenting with acute ischemic stroke.

Methods:

This study was conducted from 2022 to 2024 at Ghaem Hospital, Mashhad. Patients presenting to the hospital's emergency department with symptoms of acute ischemic stroke were identified based on NIHSS clinical examination. NIHSS was assessed at admission, ASPECTS on baseline imaging, and the modified Rankin Scale at admission (mRS0) and 90 days post-stroke (mRS90). CBS, DWI-ASPECTS, mRS, and the modified CBS were measured for each patient. The collected data were analyzed using SPSS statistical software, and the prognostic value of both the original and modified CBS was assessed for predicting different outcomes, including mortality, disability, and severe disease.

Results:

A total of 130 patients were included (mean age 64.9 ± 14.1 years; 53.1% male). Compared to CBS, mCBS showed stronger correlations with NIHSS (ρ=-0.569, p < 0.0001) and mRS90 (ρ=-0.568, p < 0.0001). For disability prediction (mRS90 ≥ 2), the AUC of mCBS was 0.807 versus 0.735 for CBS (p = 0.0019). For severity (NIHSS ≥ 15), the AUC was 0.778 versus 0.720 (p = 0.0156). For mortality, AUCs were 0.708 and 0.681, respectively, with no significant difference (p = 0.3821).

Conclusion:

Based on the findings of this study, the modified CBS has greater prognostic value than the original CBS for predicting outcomes in acute stroke patients. If confirmed by future studies, the modified CBS may be considered a potential replacement for the conventional CBS scoring system.

Keywords:

Clot burden score Ischemic Outcome Prediction Stroke Stroke large vessel occlusion Stroke prognosis TOF-MRA

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