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Effect of Collaterals on Clinical Presentation, Baseline Imaging, Complications, and Outcome in Acute Stroke

E M Fanou1, J Knight1, R I Aviv2

  • 1From the Division of Neuroradiology (E.M.F., J.K., R.I.A., S.-P.H., S.P.S., L.Z.), Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

AJNR. American Journal of Neuroradiology
|October 17, 2015
PubMed

Insights

Good collateral circulation independently predicts better outcomes in acute ischemic stroke patients. Combining collateral assessment with total ischemic volume improves prediction of final infarct size and functional outcomes.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Research

Background:

  • Collateral circulation on computed tomography angiography (CTA) is a known predictor of outcomes in acute ischemic stroke.
  • The added benefit of collateral status over computed tomography perfusion (CTP)-derived total ischemic volume requires further evaluation.

Purpose of the Study:

  • To assess the predictive value of collateral circulation.
  • To determine the added benefit of collateral status compared to CTP-derived total ischemic volume.
  • To evaluate prediction of baseline NIHSS score, total ischemic volume, hemorrhagic transformation, final infarct size, and modified Rankin Scale (mRS) score >2.

Main Methods:

  • Retrospective study of 395 acute ischemic stroke patients.
  • Dichotomization based on recanalization status and collateral status.
  • Quantification of clot burden score (CTA), total ischemic volumes (CTP), and final infarct size (CT/MRI).
  • Univariate and multivariate analyses adjusting for rtPA status; model comparison using F or likelihood ratio tests.

Main Results:

  • Collateral presence independently predicted outcomes, with greater benefit in recanalization-negative patients (16.5% variability for final infarct size, 19.2% for mRS >2).
  • A combined model of collateral score and total ischemic volume was superior for predicting mRS >2 and final infarct size (24% and 28% variability, respectively).
  • In recanalization-positive patients, the combined model showed a smaller, but significant, improvement for hemorrhagic transformation and final infarct prediction.

Conclusions:

  • Collateral circulation is an independent predictor of outcomes in acute ischemic stroke.
  • Its predictive significance is greater in recanalization-negative patients.
  • Total ischemic volume assessment complements collateral scoring for predicting outcomes.
Abstract

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