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Updated: Jan 4, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Comparison Between Perfusion- and Collateral-Based Triage for Endovascular Thrombectomy in a Late Time Window
Byungjun Kim1, Cheolkyu Jung2, Hyo Suk Nam3
1From the Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul (B.K.).
Insights
Collateral-based triage demonstrates good reliability and comparable effectiveness to perfusion-based methods for selecting patients for endovascular thrombectomy (EVT) in extended time windows. This approach reliably identifies suitable candidates for EVT beyond six hours post-stroke.
Area of Science:
- Neurology
- Interventional Radiology
- Medical Imaging
Background:
- Perfusion-based triage is established for selecting patients for endovascular thrombectomy (EVT) within a late time window.
- Evaluating collateral status offers a potential alternative triage method for EVT in extended timeframes.
Purpose of the Study:
- To assess the interrater reliability of collateral-based triage for EVT.
- To compare the efficacy of collateral-based triage versus perfusion-based triage in predicting clinical outcomes for EVT in patients presenting beyond 6 hours.
Main Methods:
- One hundred thirty-two patients with anterior circulation large artery occlusion (6-24 hours) underwent CT angiography and CT perfusion.
- Patients were categorized into EVT-eligible/ineligible groups using both perfusion- and collateral-based triage methods.
- Interrater reliability and clinical outcomes (good outcome rates) were analyzed for eligible patients receiving EVT.
Main Results:
- Collateral-based triage showed good interrater reliability (generalized κ=0.73).
- Agreement between perfusion- and collateral-based triage was moderate (κ=0.41).
- No significant difference in good outcome rates was observed between patients selected by either triage method (55.1% vs. 62.0%, P=0.0675).
Conclusions:
- Collateral-based triage is a reliable method with good interrater reliability for EVT selection in the extended time window.
- Its efficacy in predicting clinical outcomes is comparable to perfusion-based triage for patients presenting beyond 6 hours.
- Collateral assessment offers a viable alternative for patient selection in extended EVT time windows.
Abstract:
Background and Purpose- Perfusion-based triage has proven to be effective and safe for selecting patients who are likely to benefit from endovascular thrombectomy (EVT) in a late time window. We investigated collateral-based triage for EVT in patients presenting beyond 6 hours, in terms of interrater reliability and efficacy in predicting clinical outcome, in comparison to perfusion-based triage. Methods- One hundred and thirty-two patients who underwent both computed tomographic angiography and computed tomography perfusion for anterior circulation large artery occlusion 6 to 24 hours after last seen well were enrolled. Patients were classified into EVT-eligible and EVT-ineligible groups according to perfusion- and collateral-based triages. We evaluated the interrater reliability of collateral-based triage and differences in good outcome rates of patients who received EVT in the EVT-eligible groups based on perfusion- and collateral-based triages. Results- Both computed tomographic angiography and computed tomography perfusion were assessable in 93 patients. Seventy-six patients were eligible for EVT according to perfusion-based triage. Among them, EVT was performed in 58, of whom 32 (55.1%) had good outcome. Sixty-nine patients were eligible for EVT based on collateral-based triage. Among them, EVT was performed in 50 patients, of whom 31 (62.0%) had good outcome. Interrater reliability of collateral-based triage was good (generalized κ=0.73 [95% CI, 0.59-0.84]). Agreement on EVT eligibility between perfusion- and collateral-based triages was moderate (κ=0.41 [95% CI, 0.16-0.61]). There was no difference in good outcome rates of patients who underwent EVT in the EVT-eligible groups based on perfusion- and collateral-based triages (55.1% versus 62.0%; P=0.0675). Conclusions- Collateral-based triage showed good interrater reliability and comparable efficacy to that of perfusion-based triage in predicting clinical outcome after EVT in patients presenting beyond 6 hours. Collateral-based triage is a reliable approach for selecting patients for EVT in the extended therapeutic time window.
