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Quantitative Collateral Assessment on CTP in the Prediction of Stroke Etiology
Insights
Patients with large-artery atherosclerosis stroke have better collateral circulation, as shown by a new quantitative method measuring maximum collateral blood flow (cCBFmax). This finding aids in predicting stroke etiology in acute ischemic stroke cases.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Large-artery atherosclerosis (LAA) stroke was hypothesized to correlate with superior collateral circulation.
- Previous assessments of collateral circulation were not quantitative.
- A novel quantitative method was needed to evaluate collateral status in stroke patients.
Purpose of the Study:
- To investigate the association between stroke etiology and collateral circulation.
- To introduce and validate a new quantitative collateral assessment method for acute ischemic stroke.
Main Methods:
- Retrospective analysis of 296 patients with proximal anterior artery occlusion undergoing CT Perfusion (CTP).
- Derivation of Cerebral Blood Flow (CBF) maps from CTP data.
- Application of a new quantitative indicator, maximum CBF of collateral vessels within the Sylvian fissure (cCBFmax), to assess collateral status.
Main Results:
- Median cCBFmax was significantly higher in patients with LAA compared to other etiologies (92 vs. 62 mL/100 g/min, P < .001).
- Higher cCBFmax was independently associated with LAA etiology (OR, 1.010; P = .017).
- The predictive model for LAA etiology achieved an AUC of 0.870 with 89.7% sensitivity and 75.2% specificity.
Conclusions:
- Patients with LAA stroke exhibit more adequate collateral perfusion supply, as quantified by the novel cCBFmax method.
- The cCBFmax measurement shows promise for predicting stroke etiology in acute ischemic stroke patients.
- This quantitative approach may enhance clinical decision-making in acute stroke management.
Background And Purpose:
Patients with stroke etiology of large-artery atherosclerosis were thought to have better collateral circulation compared with patients with other stroke etiologies. We aimed to investigate the association between stroke etiology and collateral circulation with a new quantitative collateral assessment method.
Materials And Methods:
This retrospective study reviewed data from consecutive patients with proximal anterior artery occlusion who underwent CTP before reperfusion therapy. CBF maps were derived from CTP. A new indicator, maximum CBF of collateral vessels within the Sylvian fissure (cCBFmax), was applied to quantitatively assess the collateral status. The relationship between collateral status and stroke etiology was investigated.
Results:
A total of 296 patients were finally analyzed. The median cCBFmax was significantly higher in patients with large-artery atherosclerosis than in those without it (92 [interquartile range, 65-123] mL/100 g/min versus 62 [interquartile range, 46-82] mL/100 g/min; P < .001). Multivariable analysis revealed that a higher cCBFmax score was independently associated with large-artery atherosclerosis etiology (OR, 1.010; 95% CI, 1.002-1.018; P = .017) after adjustment. The area under the curve, sensitivity, and specificity of the final model in predicting the etiology of large-artery atherosclerosis were 0.870, 89.7%, and 75.2%, respectively.
Conclusions:
Patients with large-artery atherosclerosis had a more adequate collateral perfusion supply with the new quantitative collateral assessment. The new quantitative collateral measurement might contribute to the prediction of stroke etiology in the acute clinical scenario for patients with acute ischemic stroke.
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