Benjamin Y Q Tan1, Kong Wan-Yee1, Prakash Paliwal1, Anil Gopinathan1, Mahendran Nadarajah1, Eric Ting1, Narayanaswamy Venketasubramanian1, Raymond C S Seet1, Bernard P L Chan1, Hock L Teoh1, Rahul Rathakrishnan1, Vijay K Sharma1, Leonard L L Yeo2. 1. From the Division of Neurology, Departments of Medicine (B.Y.Q.T., K.W.-Y., P.P., R.C.S.S., B.P.L.C., H.L.T., R.R., V.K.S., L.L.L.Y.) and Diagnostic Imaging (A.G., E.T.), National University Health System, Singapore; Department of Neuroradiology, National Neuroscience Institute, Singapore (M.N.); and Neuroscience Department, Raffles Neuroscience Center, Raffles Medical Group, Singapore (N.V.). 2. From the Division of Neurology, Departments of Medicine (B.Y.Q.T., K.W.-Y., P.P., R.C.S.S., B.P.L.C., H.L.T., R.R., V.K.S., L.L.L.Y.) and Diagnostic Imaging (A.G., E.T.), National University Health System, Singapore; Department of Neuroradiology, National Neuroscience Institute, Singapore (M.N.); and Neuroscience Department, Raffles Neuroscience Center, Raffles Medical Group, Singapore (N.V.). leonard_ll_yeo@nuhs.edu.sg.
Abstract
BACKGROUND AND PURPOSE: In acute ischemic stroke, large early infarct size estimated by the Alberta Stroke Program Early CT Score (ASPECTS) is associated with poorer outcomes and is a relative contraindication for recanalization therapies. The state of the intracranial collateral circulation influences the functional outcome and may be a variable to consider before thrombolysis. We evaluated the prognostic effect of the collateral circulation in patients with thrombolyzed acute ischemic stroke who have large early infarct sizes as indicated by low ASPECTS. MATERIALS AND METHODS: Patients with anterior circulation acute ischemic stroke who received a computed tomographic angiogram and subsequent treatment with intravenous tissue-type plasminogen activator from 2010 to 2013 were studied. Two independent neuroradiologists determined their ASPECTS. We stratified patients using ASPECTS into 2 groups: large volume infarcts (ASPECTS≤7 points) and small volume infarcts (ASPECTS 8-10). In addition, we evaluated a third group with very large volume infarcts (ASPECTS≤5 points). We then analyzed the 3 subgroups using the Maas, Tan, and ASPECTS-collaterals grading systems of the computed tomographic angiogram intracranial collaterals. Good outcomes were defined by modified Rankin Scale score of 0 to 2 at 3 months. RESULTS: A total of 300 patients were included in the final analysis. For patients with very large volume infarcts (ASPECTS≤5 points), univariable analysis showed that younger age, male sex, lower National Institute of Health Stroke Scale (NIHSS), lower systolic blood pressure, and good collaterals by Maas, Tan, or ASPECTS-collaterals grading were predictors of good outcomes. On multivariate analysis, younger age (odds ratio, 0.93; 95% confidence interval, 0.89-0.97; P=0.002) and good collaterals by ASPECTS-collaterals system (odds ratio, 1.34; 95% confidence interval, 1.15-1.57; P<0.001) were associated with good outcomes. CONCLUSIONS: In patients with large and very large volume infarcts, good collaterals as measured by the ASPECTS-collaterals system is associated with improved outcomes and can help select patients for intravenous thrombolysis.
BACKGROUND AND PURPOSE: In acute ischemic stroke, large early infarct size estimated by the Alberta Stroke Program Early CT Score (ASPECTS) is associated with poorer outcomes and is a relative contraindication for recanalization therapies. The state of the intracranial collateral circulation influences the functional outcome and may be a variable to consider before thrombolysis. We evaluated the prognostic effect of the collateral circulation in patients with thrombolyzed acute ischemic stroke who have large early infarct sizes as indicated by low ASPECTS. MATERIALS AND METHODS:Patients with anterior circulation acute ischemic stroke who received a computed tomographic angiogram and subsequent treatment with intravenous tissue-type plasminogen activator from 2010 to 2013 were studied. Two independent neuroradiologists determined their ASPECTS. We stratified patients using ASPECTS into 2 groups: large volume infarcts (ASPECTS≤7 points) and small volume infarcts (ASPECTS 8-10). In addition, we evaluated a third group with very large volume infarcts (ASPECTS≤5 points). We then analyzed the 3 subgroups using the Maas, Tan, and ASPECTS-collaterals grading systems of the computed tomographic angiogram intracranial collaterals. Good outcomes were defined by modified Rankin Scale score of 0 to 2 at 3 months. RESULTS: A total of 300 patients were included in the final analysis. For patients with very large volume infarcts (ASPECTS≤5 points), univariable analysis showed that younger age, male sex, lower National Institute of Health Stroke Scale (NIHSS), lower systolic blood pressure, and good collaterals by Maas, Tan, or ASPECTS-collaterals grading were predictors of good outcomes. On multivariate analysis, younger age (odds ratio, 0.93; 95% confidence interval, 0.89-0.97; P=0.002) and good collaterals by ASPECTS-collaterals system (odds ratio, 1.34; 95% confidence interval, 1.15-1.57; P<0.001) were associated with good outcomes. CONCLUSIONS: In patients with large and very large volume infarcts, good collaterals as measured by the ASPECTS-collaterals system is associated with improved outcomes and can help select patients for intravenous thrombolysis.
Authors: M Laflamme; S Carrondo-Cottin; M-M Valdès; D Simonyan; M-È Audet; J-L Gariépy; M-C Camden; C Gariépy; S Verreault; P Lavoie Journal: AJNR Am J Neuroradiol Date: 2022-09-22 Impact factor: 4.966
Authors: M A Almekhlafi; W G Kunz; B K Menon; R A McTaggart; M V Jayaraman; B W Baxter; D Heck; D Frei; C P Derdeyn; T Takagi; A H Aamodt; I M R Fragata; M D Hill; A M Demchuk; M Goyal Journal: AJNR Am J Neuroradiol Date: 2019-01-31 Impact factor: 3.825
Authors: Olivia Sobczyk; Jorn Fierstra; Lakshmikumar Venkatraghavan; Julien Poublanc; James Duffin; Joseph A Fisher; David J Mikulis Journal: Front Physiol Date: 2021-07-07 Impact factor: 4.566
Authors: Johanna Rosemarie Leyhe; Ioannis Tsogkas; Amélie Carolina Hesse; Daniel Behme; Katharina Schregel; Ismini Papageorgiou; Jan Liman; Michael Knauth; Marios-Nikos Psychogios Journal: J Neurointerv Surg Date: 2016-12-20 Impact factor: 5.836