Good collateral circulation (CC) is associated with favorable outcomes in acute stroke, but the best technique to evaluate collaterals is controversial. Single-phase computed tomography angiography (sCTA) is widely used but lacks temporal resolution. We aim to compare CC evaluation by sCTA and multiphase CTA (mCTA) as predictors of outcome in endovascular treated patients. METHODS: Consecutive endovascular treated patients with M1 middle cerebral artery (MCA) or terminal intracranial carotid artery (TICA) occlusion confirmed by sCTA were included. Two more CTA acquisitions with 8- and 16-second delays were performed for mCTA. Endovascular thrombectomy was performed independently of the CC status according to a local protocol [Alberta Stroke Program Early CT score (ASPECTS) >6, modified Rankin scale (mRS) score <3]. CC on sCTA and mCTA were compared. RESULTS: 108 patients were included. Their mean age was 69.6 ± 13 years and their median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range 8). 79 (73.1%) had M1 MCA and 29 (26.9%) TICA occlusions. The mean time from symptom onset to CTA was 146.8 ± 96.5 min. On sCTA, 50.9% patients presented good CC vs. 57.5% on mCTA. Good CC status in both sCTA and mCTA had a lower 24-hour infarct volume (27.4 vs. 74.8 cm3 on sCTA, p = 0.04; 17.2 vs. 97.8 cm3 on mCTA, p < 0.01). However, only good CC on mCTA was associated with lower 24-hour (5 vs. 8.5, p = 0.04) and median discharge NIHSS (2 vs. 4.5, p = 0.04) scores and functional independency (mRS score <3) at 3 months (76.9 vs. 23.1%, p < 0.01). In a logistic regression model including age, NIHSS, ASPECTS and recanalization, only age (OR 0.96, 95% CI 0.93-0.99, p = 0.02) and good CC on mCTA (OR 5, 95% CI 1.99-12.6, p < 0.01) were independent predictors of functional outcome at 3 months. CONCLUSION: CC evaluation by mCTA is a better prognostic marker than CC evaluation by sCTA for clinical and functional endpoints in acute stroke patients treated with endovascular thrombectomy.
Good collateral circulation (CC) is associated with favorable outcomes in acute stroke, but the best technique to evaluate collaterals is controversial. Single-phase computed tomography angiography (sCTA) is widely used but lacks temporal resolution. We aim to compare CC evaluation by sCTA and multiphase CTA (mCTA) as predictors of outcome in endovascular treated patients. METHODS: Consecutive endovascular treated patients with M1 middle cerebral artery (MCA) or terminal intracranial carotid artery (TICA) occlusion confirmed by sCTA were included. Two more CTA acquisitions with 8- and 16-second delays were performed for mCTA. Endovascular thrombectomy was performed independently of the CC status according to a local protocol [Alberta Stroke Program Early CT score (ASPECTS) >6, modified Rankin scale (mRS) score <3]. CC on sCTA and mCTA were compared. RESULTS: 108 patients were included. Their mean age was 69.6 ± 13 years and their median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range 8). 79 (73.1%) had M1 MCA and 29 (26.9%) TICA occlusions. The mean time from symptom onset to CTA was 146.8 ± 96.5 min. On sCTA, 50.9% patients presented good CC vs. 57.5% on mCTA. Good CC status in both sCTA and mCTA had a lower 24-hour infarct volume (27.4 vs. 74.8 cm3 on sCTA, p = 0.04; 17.2 vs. 97.8 cm3 on mCTA, p < 0.01). However, only good CC on mCTA was associated with lower 24-hour (5 vs. 8.5, p = 0.04) and median discharge NIHSS (2 vs. 4.5, p = 0.04) scores and functional independency (mRS score <3) at 3 months (76.9 vs. 23.1%, p < 0.01). In a logistic regression model including age, NIHSS, ASPECTS and recanalization, only age (OR 0.96, 95% CI 0.93-0.99, p = 0.02) and good CC on mCTA (OR 5, 95% CI 1.99-12.6, p < 0.01) were independent predictors of functional outcome at 3 months. CONCLUSION: CC evaluation by mCTA is a better prognostic marker than CC evaluation by sCTA for clinical and functional endpoints in acute strokepatients treated with endovascular thrombectomy.
Authors: Bijoy K Menon; Christopher D d'Esterre; Emmad M Qazi; Mohammed Almekhlafi; Leszek Hahn; Andrew M Demchuk; Mayank Goyal Journal: Radiology Date: 2015-01-29 Impact factor: 11.105
Authors: Oh Young Bang; Jeffrey L Saver; Suk Jae Kim; Gyeong-Moon Kim; Chin-Sang Chung; Bruce Ovbiagele; Kwang Ho Lee; David S Liebeskind Journal: Stroke Date: 2011-01-13 Impact factor: 7.914
Authors: Marc Ribo; Alan Flores; Marta Rubiera; Jorge Pagola; Joao Sargento-Freitas; David Rodriguez-Luna; Pilar Coscojuela; Olga Maisterra; Socorro Piñeiro; Francisco J Romero; Jose Alvarez-Sabin; Carlos A Molina Journal: Stroke Date: 2011-09-29 Impact factor: 7.914
Authors: Jessica C Tan; William P Dillon; Songling Liu; Felix Adler; Wade S Smith; Max Wintermark Journal: Ann Neurol Date: 2007-06 Impact factor: 10.422
Authors: Matthew B Maas; Michael H Lev; Hakan Ay; Aneesh B Singhal; David M Greer; Wade S Smith; Gordon J Harris; Elkan Halpern; André Kemmling; Walter J Koroshetz; Karen L Furie Journal: Stroke Date: 2009-07-09 Impact factor: 7.914
Authors: G A Christoforidis; C Karakasis; Y Mohammad; L P Caragine; M Yang; A P Slivka Journal: AJNR Am J Neuroradiol Date: 2008-09-03 Impact factor: 3.825
Authors: M A Almekhlafi; W G Kunz; R A McTaggart; M V Jayaraman; M Najm; S H Ahn; E Fainardi; M Rubiera; A V Khaw; A Zini; M D Hill; A M Demchuk; M Goyal; B K Menon Journal: AJNR Am J Neuroradiol Date: 2019-12-05 Impact factor: 3.825
Authors: Melissa S Eng; Anand V Patel; Richard B Libman; Paul Wright; Jeffrey M Katz Journal: Curr Atheroscler Rep Date: 2017-10-24 Impact factor: 5.113
Authors: Mingxue Jing; Joshua Y P Yeo; Staffan Holmin; Tommy Andersson; Fabian Arnberg; Paul Bhogal; Cunli Yang; Anil Gopinathan; Tian Ming Tu; Benjamin Yong Qiang Tan; Ching Hui Sia; Hock Luen Teoh; Prakash R Paliwal; Bernard P L Chan; Vijay Sharma; Leonard L L Yeo Journal: Clin Neuroradiol Date: 2021-10-28 Impact factor: 3.649
Authors: Johanna Maria Ospel; Ryan McTaggart; Nima Kashani; Marios Psychogios; Mohammed Almekhlafi; Mayank Goyal Journal: Semin Intervent Radiol Date: 2020-05-14 Impact factor: 1.513