Danilo Toni1, Salvatore Mangiafico2, Manuel Cappellari3, Valentina Saia4, Giovanni Pracucci5, Fainardi Enrico6, Arturo Consoli7,2, Sergio Nappini2, Lucio Castellan8, Sandra Bracco9, Mauro Bergui10, Mirco Cosottini11, Alessandra Briatico Vangosa12, Sergio Vinci13, Maria Ruggiero14, Edoardo Puglielli15, Luigi Chiumarulo16, Giacomo Cester17, Chiara Comelli18, Umberto Silvagni19, Daniele Morosetti20, Valentina Caldiera21, Nicola Cavasin22, Valeria Ledda23, Giuseppina Sanfilippo24, Andrea Saletti25, Pietro Filauri26, Ivan Gallesio27, Nunzio Paolo Nuzzi28, Pitero Amistá29, Cecilia Zivelonghi30, Mauro Plebani31, Marco Pavia32, Daniele Romano33, Francesco Biraschi34, Roberto Menozzi35, Roberto Gasparotti36, Andrea Giorgianni37, Andrea Zini38, Domenico Inzitari5. 1. Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy. 2. Interventional Neurovascular Unit, Careggi University Hospital, Florence, Italy. 3. Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy. manuel_cappellari@libero.it. 4. Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy. 5. Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy. 6. Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy. 7. Service de Neuroradiologie Diagnostique et Thérapeutique Hôpital Foch, Suresnes, France. 8. Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 9. Unit of Neuroimaging and Neurointervention, University Hospital of Siena, Siena, Italy. 10. Interventional Neuroradiology Unit, Città della Salute e della Scienza-Molinette, Turin, Italy. 11. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. 12. Diagnostic and Interventional Neuroradiology Unit-"SS. Annunziata" Hospital, Taranto, Italy. 13. UOC Neuroradiology, Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy. 14. Department of Neuroradiology, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy. 15. Vascular and Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy. 16. UOS Neuroradiologia Interventistica, AOU Consorziale Policlinico, Bari, Italy. 17. Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy. 18. Interventional Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy. 19. Interventional Neuroradiology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy. 20. Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy. 21. Department of Neuroradiology, S. Corona Hospital, Pietra Ligure, Italy. 22. Neuroradiology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy. 23. Vascular and Interventional Neuroradiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy. 24. Radiologia e Neuroradiologia Diagnostica e Interventistica, IRCCS Policlinico San Matteo, Pavia, Italy. 25. Interventional Neuroradiology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy. 26. Neuroradiology Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy. 27. Neuroradiological Unit, Department of Radiology, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy. 28. Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy. 29. Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy. 30. Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy. 31. Neuroradiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 32. Neuroradiology Unit, Fondazione Poliambulanza, Brescia, Italy. 33. UOC Neuroradiologia, AUO S. Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy. 34. Department of Human Neurosciences, Interventional Neuroradiology, Università degli Studi di Roma Sapienza, Rome, Italy. 35. Neuroradiology Unit, Ospedale Universitario, Parma, Italy. 36. Neuroradiology Unit, Spedali Civili, Brescia, Italy. 37. Neuroradiology Department, Ospedale di Circolo-ASST Sette Laghi, Varese, Italy. 38. Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy.
Abstract
BACKGROUND: The Careggi Collateral Score (CCS) (qualitative-quantitative evaluation) was developed from a single-centre cohort as an angiographic score to describe both the extension and effectiveness of the pial collateral circulation in stroke patients with occlusion of the anterior circulation. We aimed to examine the association between CCS (quantitative evaluation) and 3-month modified Rankin Scale (mRS) score in a large multi-center cohort of patients receiving thrombectomy for stroke with occlusion of middle cerebral artery (MCA). METHODS: We conducted a study on prospectively collected data from 1284 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. According to the extension of the retrograde reperfusion in the cortical anterior cerebral artery (ACA)-MCA territories, CCS ranges from 0 (absence of retrograde filling) to 4 (visualization of collaterals until the alar segment of the MCA). RESULTS: Using CCS of 4 as reference, CCS grades were associated in the direction of unfavourable outcome on 3-month mRS shift (0 to 6); significant difference was found between CCS of 0 and CCS of 1 and between CCS of 3 and CCS of 4. CCS ≥ 3 was the optimal cut-off for predicting 3-month excellent outcome, while CCS ≥ 1 was the optimal cut-off for predicting 3-month survival. CCS of 0 and CCS < 3 were associated in the direction of unfavourable recanalization on TICI shift (0 to 3) compared with CCS ≥ 1 and CCS ≥ 3, respectively. Compared with CCS ≥ 3 as reference, CCS of 0 and CCS 1 to 2 were associated in the direction of unfavourable recanalization on TICI shift. There was no evidence of heterogeneity of effects of successful recanalization and procedure time ≤ 60 min on 3-month mRS shift across CCS categories. CONCLUSION: The CCS could provide a future advantage for improving the prognosis in patients receiving thrombectomy for stroke with M1 or M1-M2 segment of the MCA occlusion.
BACKGROUND: The Careggi Collateral Score (CCS) (qualitative-quantitative evaluation) was developed from a single-centre cohort as an angiographic score to describe both the extension and effectiveness of the pial collateral circulation in stroke patients with occlusion of the anterior circulation. We aimed to examine the association between CCS (quantitative evaluation) and 3-month modified Rankin Scale (mRS) score in a large multi-center cohort of patients receiving thrombectomy for stroke with occlusion of middle cerebral artery (MCA). METHODS: We conducted a study on prospectively collected data from 1284 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. According to the extension of the retrograde reperfusion in the cortical anterior cerebral artery (ACA)-MCA territories, CCS ranges from 0 (absence of retrograde filling) to 4 (visualization of collaterals until the alar segment of the MCA). RESULTS: Using CCS of 4 as reference, CCS grades were associated in the direction of unfavourable outcome on 3-month mRS shift (0 to 6); significant difference was found between CCS of 0 and CCS of 1 and between CCS of 3 and CCS of 4. CCS ≥ 3 was the optimal cut-off for predicting 3-month excellent outcome, while CCS ≥ 1 was the optimal cut-off for predicting 3-month survival. CCS of 0 and CCS < 3 were associated in the direction of unfavourable recanalization on TICI shift (0 to 3) compared with CCS ≥ 1 and CCS ≥ 3, respectively. Compared with CCS ≥ 3 as reference, CCS of 0 and CCS 1 to 2 were associated in the direction of unfavourable recanalization on TICI shift. There was no evidence of heterogeneity of effects of successful recanalization and procedure time ≤ 60 min on 3-month mRS shift across CCS categories. CONCLUSION: The CCS could provide a future advantage for improving the prognosis in patients receiving thrombectomy for stroke with M1 or M1-M2 segment of the MCA occlusion.