Single-phase computed tomography angiography sufficiently predicts outcomes after mechanical thrombectomy

Area of Science:

• Neuroimaging
• Vascular Neurology
• Interventional Neuroradiology

Background:

• Arterial collateral (AC) and venous opacification (VO) are imaging markers for predicting outcomes in mechanical thrombectomy (MT).
• Previous studies utilized single-phase or multiphase computed tomography angiography (CTA) for AC assessment.
• Venous opacification (VO) has recently emerged as a potential imaging marker.

Purpose of the Study:

• To compare the efficacy of arterial collateral (AC) and venous opacification (VO) as predictors of clinical outcomes following mechanical thrombectomy (MT).

Main Methods:

• Retrospective analysis of patients with proximal anterior circulation occlusion undergoing MT.
• Assessment of AC using modified Tan score, Miteff score (single-phase CTA), and pial arterial filling score (multiphase CTA).
• Evaluation of VO using cortical vein opacification score; favorable outcome defined as modified Rankin Scale 0-2 at 90 days.

Main Results:

• Adequate AC, particularly via the modified Tan score (OR 7.3, p<0.001) and Miteff score (OR 4.5, p=0.009), significantly predicted favorable MT outcomes.
• Adequate VO did not significantly predict favorable outcomes.
• The modified Tan score for AC demonstrated the largest area under the curve (0.730) compared to VO (0.577).

Conclusions:

• Adequate arterial collateral (AC) assessment in single-phase computed tomography angiography (CTA) is a reliable imaging marker for predicting favorable outcomes after mechanical thrombectomy (MT).
• Venous opacification (VO) is less effective than AC for predicting MT outcomes.
• Single-phase CTA is sufficient for evaluating AC in the context of MT outcome prediction.