Collateral Assessment by CT Angiography as a Predictor of Outcome in Symptomatic Cervical Internal Carotid Artery
S Sundaram1, S Kannoth2, B Thomas2
1From the Department of Neurology (S.S., P.N.S.), Comprehensive Stroke Care Program.
Insights
CT angiography can predict stroke outcomes in patients with cervical internal carotid artery occlusion. Poor collateral circulation indicates a higher risk of stroke severity and poor 3-month outcomes.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Cervical internal carotid artery (ICA) occlusion presents with diverse symptoms, including stroke and transient ischemic attacks.
- Patient outcomes are significantly influenced by the brain's ability to compensate using collateral pathways.
- Assessing collateral circulation is crucial for predicting outcomes in these patients.
Purpose of the Study:
- To determine if collateral circulation, evaluated by CT angiography (CTA), can predict stroke severity and 3-month outcomes.
- To investigate the role of specific collateral vessels in influencing patient prognosis.
Main Methods:
- Retrospective study of 65 patients with symptomatic cervical ICA occlusion.
- Collateral vessels (anterior/posterior communicating arteries, ophthalmic artery, leptomeningeal arteries) assessed using CTA.
- Poor 3-month outcome defined as modified Rankin Scale score ≥3.
Main Results:
- 50.8% of patients experienced a poor 3-month outcome.
- Absence of the ipsilateral ophthalmic artery and poor leptomeningeal collaterals predicted stroke severity and poor outcome.
- Inadequate flow through secondary collaterals (OR, 4.5) and higher NIHSS scores (OR, 19.2) independently predicted poor 3-month outcomes.
Conclusions:
- CT angiography assessment of collateral circulation is a valuable tool for predicting 3-month outcomes.
- Identifying inadequate collateral flow can help stratify risk in patients with cervical ICA occlusion.
Background And Purpose:
Cervical internal carotid artery occlusion can present with varied clinical manifestations such as transient ischemic attack, stroke, and chronic ocular ischemia, or can be asymptomatic. The outcome in these patients is considerably influenced by cerebral hemodynamic compensatory adaptation of the intracranial collateral pathways. Our aim was to study whether collateral circulation as assessed by CT angiography can predict 3-month outcome and initial stroke severity in patients with symptomatic cervical ICA occlusion.
Materials And Methods:
This was a retrospective study of 65 patients with symptomatic cervical ICA occlusion from January 2011 to December 2013. The collateral vessels (anterior and posterior communicating arteries, ophthalmic artery, and leptomeningeal arteries) were assessed by CTA. The outcome at 3 months was defined as poor if the modified Rankin Scale score was ≥3.
Results:
The mean age of subjects was 57 ± 11.6 years (range, 32-80 years), and 92% were men. Thirty-three (50.8%) patients had poor outcome. Absence of the ipsilateral ophthalmic artery, poor leptomeningeal collaterals, and <2 collaterals were predictors of stroke severity at onset and poor 3-month outcome in univariate analysis. In the multiple logistic regression analysis, inadequate flow through the secondary collaterals (ipsilateral ophthalmic artery or leptomeningeal collaterals; OR, 4.5; 95% CI, 1.4-14.9; P = .01) and higher NIHSS score at stroke onset (OR, 19.2; 95% CI, 2.2-166.2; P = .007) independently predicted poor outcome at 3 months.
Conclusions:
Assessment of collateral circulation with CTA can be a useful predictor of 3-month outcome in patients with symptomatic cervical ICA occlusion.
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