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Impact of Collateral Status Evaluated by Dynamic Computed Tomographic Angiography on Clinical Outcome in Patients

Ido R van den Wijngaard1, Jelis Boiten2, Ghislaine Holswilder2

  • 1From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.). wijngaardido@gmail.com.

Stroke
|November 7, 2015
PubMed

Insights

Dynamic CT angiography (CTA) offers superior prediction of stroke outcomes compared to single-phase CTA. This advanced imaging technique improves assessment of collateral circulation, aiding in better patient management after ischemic stroke.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Collateral circulation status is a key predictor of outcomes in acute ischemic stroke.
  • Assessing collateral blood flow is crucial for stroke management.
  • Computed tomographic angiography (CTA) is utilized for evaluating collateral status.

Purpose of the Study:

  • To compare the predictive value of dynamic CTA versus conventional single-phase CTA for collateral blood flow assessment.
  • To determine which CTA strategy offers better prediction of clinical outcomes after acute ischemic stroke.

Main Methods:

  • Seventy patients with proximal middle cerebral artery occlusion were included.
  • Dynamic CTA and single-phase CTA were performed within 9 hours of stroke onset.
  • Modified Rankin Scale (mRS) score at 3 months was used to define poor outcome (mRS ≥3).
  • Logistic regression and area under the curve (AUC) were used to assess prognostic value.

Main Results:

  • Poor collaterals on both single-phase CTA (RR 1.8) and dynamic CTA (RR 2.0) were associated with increased risk of poor outcome.
  • Dynamic CTA demonstrated superior prediction of poor clinical outcome (AUC 0.84) compared to single-phase CTA (AUC 0.80).
  • The difference in predictive accuracy was statistically significant (P<0.01) for dynamic CTA.

Conclusions:

  • Dynamic CTA provides a more accurate assessment of collateral circulation for predicting clinical outcomes at 3 months post-stroke.
  • This finding supports the use of dynamic CTA in clinical practice for acute ischemic stroke patients.
Abstract

Keywords:
angiographyfour-dimensional computed tomographyriskstroke

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