Computed tomography angiography source images closely reflect the integrity of collateral circulation
Niko Sillanpää1, Jukka Tapio Saarinen2, Harri Rusanen3
1Medical Imaging Center, Tampere University Hospital, PL 2000, 33521 Tampere, Finland.
Insights
Collateral Score (CS) is a significant predictor of clinical outcome after intravenous thrombolysis, while CT angiography source images (CTA-SI) ASPECTS is not when considered alongside CS and clot location.
Area of Science:
- Neuroimaging
- Stroke Imaging
- Cerebrovascular Diseases
Background:
- Evaluating collateral circulation, thrombus location, and infarct extent is crucial for predicting outcomes in stroke patients receiving thrombolytic therapy.
- CT angiography source images (CTA-SI) are used to assess these factors.
Purpose of the Study:
- To investigate the interplay between collateral circulation, thrombus location, and infarct extent using CTA-SI in predicting clinical outcomes.
- To determine the predictive value of CTA-SI ASPECTS and collateral score (CS) for favorable outcomes after thrombolysis.
Main Methods:
- Retrospective analysis of 105 patients with anterior circulation occlusion treated with intravenous thrombolysis (<3h).
- Assessment of collateral circulation using Collateral Score (CS) and infarct extent using Alberta Stroke Program Early CT Score (ASPECTS) from CTA-SI.
- Logistic regression analysis to predict favorable three-month modified Rankin Scale (mRS 0-2).
Main Results:
- CTA-SI ASPECTS and CS were highly correlated (Spearman's rho=0.63, P=0.01).
- Good collaterals (CS 2-4) were associated with better CTA-SI ASPECTS scores (ANOVA P<0.001).
- In univariate analysis, good CTA-SI ASPECTS predicted favorable outcome (P<0.001), but this was not significant in multivariate analysis when CS was included (P=0.43).
Conclusions:
- CTA-SI and CS provide overlapping information regarding stroke severity and outcome prediction.
- CS is a significant predictor of clinical outcome, whereas CTA-SI ASPECTS is not when considered with CS and clot location.
- CTA-SI may still be valuable for assessing ischemic changes if imaging protocols are optimized.
Background:
We studied the interplay between collateral circulation, the location of the thrombus and infarct extent based on evaluation of CT angiography source images (CTA-SI) in predicting the clinical outcome of patients treated with intravenous thrombolytic therapy (<3h) in a retrospective cohort.
Methods:
Anterior circulation occlusion was detected with CTA in 105 patients. The site of the occlusion was recorded, collaterals were assessed with Collateral Score (CS) and Alberta Stroke Program Early CT Score (ASPECTS) was evaluated from CTA-SI, and entered into logistic regression analysis to predict favorable clinical outcome (three-month modified Rankin Scale 0-2).
Results:
CTA-SI ASPECTS was highly correlated with CS (Spearman's rho=0.63, P=0.01). Not a single patient with good collaterals (CS 2-4) had a poor CTA-SI scan (ASPECTS 0-7). The mean CTA-SI ASPECTS score became progressively lower when the status of the collateral circulation deteriorated (ANOVA P<0.001). In univariate analysis a good CTA-SI scan at the admission predicted favorable three-month outcome (P<0.001). In a multivariate model containing CTA-SI ASPECTS, CS and the site of the occlusion along with significant clinical parameters, CTA-SI ASPECTS was rendered non-significant (P=0.43) in the presence of CS.
Conclusions:
CTA-SI and CS convey overlapping information. CTA-SI is not a significant predictor of the clinical outcome three months after intravenous thrombolysis when the other CTA-based parameters, CS and the clot location, are considered simultaneously. CTA-SI may have a role in the assessment of the extent of irreversible ischemic changes at admission if contrast injection and image acquisition protocols are designed suitably.
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