Collateral score on CT angiography in patients with acute ischemic stroke - A retrospective study
DOI:
https://doi.org/10.32896/cvns.v1n1.1-7Keywords:
CTA brain, Collateral score, Clinical outcome, Acute ischemic stroke, Modified Rankin scale, Computed, Tomography, Angiography, Brain, Clinical, Acute, Ischemic, Stroke, Rankin, ScaleAbstract
Objective: Clinically assessing the status of cerebral collaterals is thought to provide invaluable diagnostic and prognostic data in managing acute ischemic stroke (AIS) patients. In this study we present a report, based on commonly used collateral grading system, assessing the correlation between the collateral status seen on CT angiography and patients’ functional outcome at Day 90 in our institution.
Method: Patients presenting to the Emergency Department within 6 hours of onset of stroke from January 2010 until December 2014 were chosen for the study. CT angiography source images were retrospectively reviewed and given a “collateral score” (CS) by a radiologist who was blinded to the patient’s clinical information on presentation, as well as the clinical outcomes at 90 days. Patients’ mRS score at 90 days was obtained retrospectively and compared against the “collateral score”.
Results: 87 patients were enrolled into this study, of which 60 (69%) were male and 27 (31%) were female with a mean age of 60.3 years. In this study, 56 (64.4%) patients had a collateral score (CS) > 2 and 31 (35.6%) patients had a CS < 2. Out of 56 patients who had a CS > 2, 51 of them (91%) had good clinical outcome with a mRS < 2. All the patients who had CS < 2 showed poor clinical outcome with a mRS > 2. The collateral score predicts accurately the clinical outcome with an area under the curve (ROC) of 0.75 (95% CI, 0.675-0.871, P=0.001). There is significant Spearman correlation between CS and the clinical outcome at Day 90, in patients with AIS during CTA analysis.
Conclusion: Our data supports the potential use of CS analysis in predicting clinical outcome of patients with AIS. Nevertheless, further study on a larger scale is strongly suggested to verify the reliability and reproducibility of CS assessment in CTA analysis prior to reperfusion in AIS patients.
References
Liebeskind, David S. "Collateral Circulation." Stroke 34 (2003): 2279-2284.
I I Ismail, O Y Mansour, M E Reda, F M Talaat. "Assessment Of Collateral Pathways In Acute Ischemic Cerebrovascular Stroke Using A Mansour Grading Scale; A New Scale, A Pilot Study." The Internet Journal of Interventional Medicine 3.1 (2013).
Seena Dehkharghani, Jalal Andre. "Imaging Approaches to Stroke and Neurovascular Disease." Neurosurgery 80.5 (2017): 681–700.
Soke Miang Chng, Esben Thade Petersen , Ivan Zimine , Yih-Yian Sitoh , C.C. Tchoyoson Lim , and Xavier Golay. "Territorial Arterial Spin Labeling in the Assessment of Collateral Circulation Comparison With Digital Subtraction Angiography." Stroke 39.12 (2008): 3248–3254.
Johannes C. Gerber, Marketa Petrova, Pawel Krukowski, Matthias Kuhn, Andrij Abramyuk, Ulf Bodechtel, Imanuel Dzialowski, Kay Engellandt, Hagen Kitzler, Lars-Peder Pallesen, Hauke Schneider, Ruediger von Kummer, Volker Puetz & Jenn Linn. "Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients." Brain and Behavior 6.9 (2016).
I.Y.L. Tan, A.M. Demchuk, J. Hopyan, L. Zhang, D. Gladstone, K. Wong, M. Martin, S.P. Symons, A.J. Fox and R.I. Aviv. "CT Angiography Clot Burden Score and Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute Middle Cerebral Artery Infarct." American Journal of Neuroradiology 30.3 (2009): 525-531
Kucinski T, Koch C, Eckert B, Becker V, Krömer H, Heesen C, Grzyska U, Freitag HJ, Röther J, Zeumer H. "Collateral circulation is an independent radiological predictor of outcome after thrombolysis in acute ischaemic stroke." Neuroradiology 45.1 (2003): 11-8.
Menon BK, Smith EE, Modi J, Patel SK, Bhatia R, Watson TW, Hill MD, Demchuk AM, Goyal M. "Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions." American Journal of Neuroradiology 32.9 (2011): 1640-1645.
Singer OC, Berkefeld J, Nolte CH, Bohner G, Haring HP, Trenkler J, Gröschel K, Müller-Forell W, Niederkorn K, Deutschmann H, Neumann-Haefelin T, Hohmann C, Bussmeyer M, Mpotsaris A, Stoll A, Bormann A, Brenck J, Schlamann MU, Jander S, Turowski B, Petzol. "Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study." Annals of Neurology 77.3 (2015): 415-424.
Elijovich L, Goyal N, Mainali S, Hoit D, Arthur AS, Whitehead M, Choudhri AF. "CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review." Journal of NeuroInterventional Surgery 8 (2016): 559-562.
Ferdinand Miteff, Christopher R. Levi, Grant A. Bateman, Neil Spratt, Patrick McElduff and Mark W. Parsons. "The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke." Brain 132 (2009): 2231–2238.
Achala Vagal, Richard Aviv, Heidi Sucharew, Mahati Reddy, Qinghua Hou, Patrik Michel, Tudor Jovin, Thomas Tomsick, Max Wintermark, and Pooja Khatri. "Collateral Clock Is More Important Than Time Clock for Tissue Fate; A Natural History Study of Acute Ischemic Strokes." Stroke 49 (2018): 2102–2107.
Raul G. Nogueira, Ashutosh P. Jadhav, Diogo C. Haussen, Alain Bonafe, Ronald F. Budzik, Parita Bhuva, Dileep R. Yavagal, Marc Ribo, Christophe Cognard, Ricardo A. Hanel, Cathy A. Sila, Ameer E. Hassan, Monica Millan, Elad I. Levy et al. "Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct." The New England Journal of Medicine 378 (2018): 11-21.
Tan JC, Dillon WP, Liu S, Adler F, Smith WS, and Wintermark M. "Systematic comparison of perfusion-CT and CT-angiography in acute stroke patients." Annals of Neurology 61.6 (2007): 533-543
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
