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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Acute Stroke: Prognostic Value of Quantitative Collateral Assessment at Perfusion CT
Feina Shi1, Xiaoxian Gong1, Chang Liu1
1From the Departments of Neurology (F.S., X.G., C.L., M.Z., Z.C., S.Y., M.L.) and Neurosurgery (Q.Z.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, China 310009; and Zhejiang University Brain Research Institute, Hangzhou, China (M.L.).
Insights
Quantifying collateral blood flow in acute ischemic stroke patients using CT perfusion can predict outcomes. Higher collateral flow is linked to reduced risk of brain bleeds and better clinical results.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute ischemic stroke (AIS) is a major cause of disability.
- Effective collateral circulation is crucial for mitigating stroke damage.
- Predictive markers for AIS outcomes are needed.
Purpose of the Study:
- To develop a quantitative CT perfusion assessment for collateral blood flow.
- To evaluate the predictive value of this assessment for patient outcomes in AIS.
- To investigate the association between collateral flow and hemorrhagic transformation.
Main Methods:
- Retrospective analysis of 204 AIS patients with M1 MCA occlusion undergoing perfusion CT.
- Calculation of maximum cerebral blood flow (CBF) in collateral vessels (cCBFmax) within the Sylvian fissure.
- Multivariable logistic regression to assess the relationship between cCBFmax and outcomes (hemorrhagic transformation, 90-day mRS).
Main Results:
- Higher cCBFmax was an independent predictor of a lower risk of hemorrhagic transformation (OR, 0.99; P = .009).
- Higher cCBFmax was independently associated with better clinical outcomes (OR, 1.02; P = .001).
- Adjustments were made for NIHSS, thrombectomy, infarct core volume, and recanalization.
Conclusions:
- Quantitative assessment of collateral blood flow using cCBFmax at perfusion CT is feasible.
- cCBFmax is a valuable predictor of clinical outcome in AIS patients.
- This quantitative measure aids in understanding collateral function's role in stroke recovery.
Abstract:
Purpose To develop a quantitative assessment of collateral perfusion at CT and to investigate its value in the prediction of outcome in patients with acute ischemic stroke (AIS). Materials and Methods This retrospective study reviewed data from consecutive patients with AIS and an occluded M1 segment of the middle cerebral artery who underwent pretreatment perfusion CT between May 2009 and August 2017. The maximum cerebral blood flow (CBF) of collateral vessels (cCBFmax) within the Sylvian fissure was calculated for each patient. Good outcome was defined as a 90-day modified Rankin scale score of 0-2. Multivariable logistic regression analysis was used to determine the relationship between cCBFmax and (a) hemorrhagic transformation and (b) clinical outcome. Results The final analysis included 204 patients (median age, 73 years; interquartile range, 62-80 years; 82 [40.2%] women). Multivariable logistic regression analysis showed that higher cCBFmax was an independent predictor for (a) a lower risk of hemorrhagic transformation (odds ratio [OR], 0.99; 95% confidence interval [CI]: 0.98, 1.00; P = .009) after adjusting for baseline National Institutes of Health Stroke Scale (NIHSS), endovascular thrombectomy, baseline infarct core volume, and recanalization and (b) better outcome (OR, 1.02; 95% CI: 1.01, 1.03; P = .001) after adjusting for age, baseline NIHSS score, endovascular thrombectomy, hypertension, baseline infarct core volume, and recanalization, respectively. Conclusion The measurement of maximum cerebral blood flow of collateral vessels within the Sylvian fissure is a feasible quantitative collateral assessment at perfusion CT. Maximum cerebral blood flow of collateral vessels was associated with clinical outcome in patients with acute ischemic stroke. © RSNA, 2019 Online supplemental material is available for this article.
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