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[Collateral score based on CT perfusion can predict the prognosis of patients with anterior circulation ischemic
Qingsong Wang1,2, Sheng Zhang1, Meixia Zhang1
1Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
Insights
CT Perfusion Collateral Score (CTP-CS) effectively predicts clinical outcomes in patients undergoing thrombectomy for anterior circulation ischemic stroke. This imaging metric shows comparable predictive value to digital subtraction angiography, aiding treatment decisions.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Ischemic stroke in the anterior circulation often requires endovascular treatment like thrombectomy.
- Assessing collateral circulation is crucial for predicting patient outcomes after such interventions.
- CT perfusion (CTP) offers a non-invasive method to evaluate collateral status, quantified by CTP collateral score (CTP-CS).
Purpose of the Study:
- To evaluate the predictive value of CT perfusion collateral score (CTP-CS) for clinical outcomes in patients with anterior circulation ischemic stroke treated with thrombectomy.
- To compare the predictive performance of CTP-CS with collateral scores derived from digital subtraction angiography (DSA-CS).
Main Methods:
- Retrospective review of acute ischemic stroke patients (anterior circulation occlusion) who underwent endovascular treatment.
- Collateral status assessed using CTP and DSA, with good collateral vessels defined as CTP-CS or DSA-CS of 3-4.
- Clinical outcome assessed by modified Rankin Scale (mRS) at 3 months; logistic regression and ROC curve analysis used for prediction evaluation.
Main Results:
- Good collateral vessels (assessed by CTP-CS or DSA-CS) were significantly associated with good clinical outcomes (mRS ≤ 2).
- CTP-CS was an independent predictor of good outcome (OR=48.404, P<0.05) after adjusting for baseline NIHSS and onset-to-recanalization time.
- CTP-CS and DSA-CS demonstrated good consistency (κ=0.697, P<0.01) and comparable predictive values (AUC=0.726, P<0.05).
Conclusions:
- CTP-CS is a valuable tool for predicting clinical outcomes in patients with anterior circulation ischemic stroke undergoing thrombectomy.
- The predictive performance of CTP-CS is comparable to that of DSA-CS, offering a potentially more accessible imaging option.
- Utilizing CTP-CS can aid in patient selection and management strategies for ischemic stroke treatment.
Objective:
To evaluate the value of collateral score based on CT perfusion (CTP-CS) in predicting the clinical outcome of patients with anterior circulation ischemic stroke after thrombectomy.
Methods:
Clinical data of acute ischemic stroke patients with anterior artery occlusion undergoing endovascular treatment in the Second Affiliated Hospital, Zhejiang University School of Medicine during October 2013 and October 2016 were retrospectively reviewed. Collateral scores were assessed based on CTP and digital subtraction angiography (DSA) images, respectively. And DSA-CS or CTP-CS 3-4 was defined as good collateral vessels. Good clinical outcome was defined as a modified Rankin Scale (mRS) ≤ 2 at 3 months after stroke. The binary logistic regression model was used to analyze the correlation between the collateral score and clinical outcome, and the receiver operating characteristic (ROC) curve was used to analyze the value of DSA-CS and CTP-CS in predicting the clinical outcome.
Results:
Among 40 patients, 33 (82.5%) acquired recanalization and 16 (40.0%) got good outcome. Compared with poor outcome group, the collateral score (all P<0.05) and the rate of good collateral vessels were higher in good outcome group (all P<0.01). After adjust baseline National Institute of Health Stroke Scale (NIHSS) and onset to recanalization time (ORT), good collateral vessels were independent factor of good outcome (CTP-CS:OR=48.404, 95% CI:1.373-1706.585, P<0.05; DSA-CS:OR=34.651, 95% CI:1.147-1047.018, P<0.05). Collateral scores based on CTP and DSA had good consistency (κ=0.697, P<0.01), and ROC curve showed that the predictive value of CTP-CS and DSA-CS were comparable (both AUC=0.726, 95%CI:0.559-0.893, P<0.05).
Conclusions:
CTP-CS can predict the clinical outcome of patients with anterior circulation ischemic stroke after thrombectomy.
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