Ido R van den Wijngaard1, Jelis Boiten2, Ghislaine Holswilder2, Ale Algra2, Diederik W J Dippel2, Birgitta K Velthuis2, Marieke J H Wermer2, Marianne A A van Walderveen2. 1. From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.). wijngaardido@gmail.com. 2. From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.).
Abstract
BACKGROUND AND PURPOSE: Status of collateral circulation is a strong predictor of outcome after acute ischemic stroke. Our aim was to compare the predictive value of strategies for collateral blood flow assessment with dynamic computed tomographic angiography (CTA) and conventional single-phase CT angiography. METHODS:Patients with a proximal middle cerebral artery occlusion underwentnoncontrast CT, single-phase CTA and whole brain CT perfusion/dynamic CTA within 9 hours after stroke onset. We defined poor outcome as a score on the modified Rankin Scale score of ≥3. The association between collateral score and clinical outcome at 3 months was analyzed with Poisson regression. The prognostic value of collateral scoring with dynamic CTA and single-phase CTA in addition to age, stroke severity, and noncontrast CT was assessed with logistic regression and summarized with the area under the curve. RESULTS:Seventy patients were included, with a mean age of 68 years. We observed an increased risk of poor outcome in patients with poor collaterals on single-phase CTA (risk ratio, 1.8; 95% confidence interval, 1.0-3.1) and on dynamic CTA (risk ratio, 2.0; 95% confidence interval, 1.5-2.7). The prediction of poor clinical outcome by means of collateral adjustment was better with dynamic CTA (area under the curve, 0.84; likelihood ratio test P<0.01) than by single-phase CTA (area under the curve, 0.80; likelihood ratio test P=0.33). CONCLUSIONS:Collateral assessment with dynamic CTA better predicts clinical outcome at 3 months than single-phase conventional CTA. CLINICAL TRIAL REGISTRATION: URL: http://www.trialregister.nl/trialreg. Unique identifier: NTR1804. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00880113.
RCT Entities:
BACKGROUND AND PURPOSE: Status of collateral circulation is a strong predictor of outcome after acute ischemic stroke. Our aim was to compare the predictive value of strategies for collateral blood flow assessment with dynamic computed tomographic angiography (CTA) and conventional single-phase CT angiography. METHODS:Patients with a proximal middle cerebral artery occlusion underwent noncontrast CT, single-phase CTA and whole brain CT perfusion/dynamic CTA within 9 hours after stroke onset. We defined poor outcome as a score on the modified Rankin Scale score of ≥3. The association between collateral score and clinical outcome at 3 months was analyzed with Poisson regression. The prognostic value of collateral scoring with dynamic CTA and single-phase CTA in addition to age, stroke severity, and noncontrast CT was assessed with logistic regression and summarized with the area under the curve. RESULTS: Seventy patients were included, with a mean age of 68 years. We observed an increased risk of poor outcome in patients with poor collaterals on single-phase CTA (risk ratio, 1.8; 95% confidence interval, 1.0-3.1) and on dynamic CTA (risk ratio, 2.0; 95% confidence interval, 1.5-2.7). The prediction of poor clinical outcome by means of collateral adjustment was better with dynamic CTA (area under the curve, 0.84; likelihood ratio test P<0.01) than by single-phase CTA (area under the curve, 0.80; likelihood ratio test P=0.33). CONCLUSIONS: Collateral assessment with dynamic CTA better predicts clinical outcome at 3 months than single-phase conventional CTA. CLINICAL TRIAL REGISTRATION: URL: http://www.trialregister.nl/trialreg. Unique identifier: NTR1804. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00880113.
Authors: Manoj Jagani; Waleed Brinjikji; Mohammad H Murad; Alejandro A Rabinstein; Harry J Cloft; David F Kallmes Journal: J Vasc Interv Neurol Date: 2017-01
Authors: I R van den Wijngaard; G Holswilder; M J H Wermer; J Boiten; A Algra; D W J Dippel; J W Dankbaar; B K Velthuis; A M M Boers; C B L M Majoie; M A A van Walderveen Journal: AJNR Am J Neuroradiol Date: 2016-03-31 Impact factor: 3.825
Authors: Ido R van den Wijngaard; Ghislaine Holswilder; Marianne A A van Walderveen; Ale Algra; Marieke J H Wermer; Osama O Zaidat; Jelis Boiten Journal: Brain Behav Date: 2016-08-31 Impact factor: 2.708
Authors: Luuk Dekker; Victor J Geraedts; Hajo Hund; Suzanne C Cannegieter; Raul G Nogueira; Mayank Goyal; Ido R van den Wijngaard Journal: Interv Neurol Date: 2018-01-25
Authors: Saeed A Alqahtani; Andrew B Stemer; Michael F McCullough; Randy S Bell; Jeffrey Mai; Ai-Hsi Liu; Rocco A Armonda Journal: Cureus Date: 2017-06-15