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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke
A M M Boers1,2,3, R Sales Barros4, I G H Jansen4,2
1From the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.) amm.boers@gmail.com.
Insights
Quantitative collateral scoring on computed tomography angiography (CTA) reliably predicts outcomes in acute ischemic stroke patients. This automated method can improve patient selection for endovascular therapy.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Collateral flow is crucial in acute ischemic stroke management.
- Baseline collateral status significantly impacts patient outcomes.
Purpose of the Study:
- To evaluate the relationship between quantitative collateral score on baseline CTA and patient outcomes in acute ischemic stroke.
- To determine if CTA acquisition timing influences this relationship.
Main Methods:
- Retrospective analysis of baseline thin-slice CTA images from the MR CLEAN trial.
- Calculation of quantitative collateral score and comparison with visual assessment.
- Assessment of 90-day modified Rankin Scale (mRS) score and follow-up infarct volume.
- Analysis of treatment effect and influence of CTA acquisition phase.
Main Results:
- Quantitative collateral score strongly correlated with visual assessment (ρ = 0.75).
- It independently predicted mRS and infarct volume, showing predictive value for functional independence.
- Significant interaction was found between quantitative collateral score and endovascular therapy effect.
- CTA acquisition phase significantly modified the collateral score's impact on outcomes.
Conclusions:
- Automated quantitative collateral scoring is a reliable, user-independent measure of collateral capacity on baseline CTA.
- This scoring method can potentially enhance patient triage for endovascular therapy in acute stroke.
Background And Purpose:
Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship.
Materials And Methods:
From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected. The quantitative collateral score was calculated as the ratio of the vascular appearance of both hemispheres and was compared with the visual collateral score. Primary outcomes were 90-day mRS score and follow-up infarct volume. The relation with outcome and the association with treatment effect were estimated. The influence of the CTA acquisition phase on the relation of collateral scores with outcome was determined.
Results:
A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score (ρ = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95% CI, .77-.86) and follow-up infarct volume (exponent β = 0.88; P < .001) per 10% increase. The quantitative collateral score showed areas under the curve of 0.71 and 0.69 for predicting functional independence (mRS 0-2) and follow-up infarct volume of >90 mL, respectively. We found significant interaction of the quantitative collateral score with the endovascular therapy effect in unadjusted analysis on the full ordinal mRS scale (P = .048) and on functional independence (P = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: P = .004; follow-up infarct volume: P < .001) in adjusted analysis.
Conclusions:
Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.
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