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Collateral Flow in Magnetic Resonance Angiography: Prognostic Value for Vertebrobasilar Stenosis With Stroke
Long Yan1,2, Ying Yu1,2, Kaijiang Kang2,3
1Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
A new score assessing posterior communicating artery and P1 segment of the posterior cerebral artery (PCoA-P1) collaterals can predict stroke recurrence in patients with intracranial vertebrobasilar atherosclerotic stenosis (IVBAS). Poor collaterals are linked to higher stroke recurrence rates.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Intracranial vertebrobasilar atherosclerotic stenosis (IVBAS) is a primary cause of posterior circulation stroke.
- Stroke recurrence remains a significant concern for patients with IVBAS, even with medical management.
- Predicting stroke recurrence is crucial for optimizing patient care and preventative strategies.
Purpose of the Study:
- To evaluate the prognostic value of a novel score for the posterior communicating artery and P1 segment of the posterior cerebral artery (PCoA-P1).
- To determine the score's ability to predict stroke recurrence in patients diagnosed with IVBAS.
Main Methods:
- Retrospective analysis of 176 patients with severe IVBAS (70%-99% stenosis).
- Development of a 5-point PCoA-P1 score based on magnetic resonance angiography assessing primary collateral status.
- Categorization of patients into no-recurrence, single-recurrence, and multiple-recurrences groups based on post-stroke events.
Main Results:
- Patients with single (OR=4.134) and multiple (OR=6.894) stroke recurrences were significantly more likely to have poor primary collaterals (PCoA-P1 score 0-1).
- Poor collaterals were associated with increased odds of stroke recurrence compared to good collaterals (PCoA-P1 score 2-4).
- The study identified a clear correlation between PCoA-P1 collateral status and the likelihood of recurrent stroke.
Conclusions:
- The PCoA-P1 score demonstrates potential as a valuable tool for predicting stroke recurrence in IVBAS patients.
- This novel scoring system may aid clinicians in identifying high-risk individuals for more intensive monitoring and treatment.
Background And Purpose:
Intracranial vertebrobasilar atherosclerotic stenosis (IVBAS) is a major cause of posterior circulation stroke. Some patients suffer from stroke recurrence despite receiving medical treatment. This study aimed to determine the prognostic value of a new score for the posterior communicating artery and the P1 segment of the posterior cerebral artery (PCoA-P1) for predicting stroke recurrence in IVBAS.
Methods:
We retrospectively enrolled patients with severe IVBAS (70%-99%). According to the number of stroke recurrences, patients were divided into no-recurrence, single-recurrence, and multiple-recurrences groups. We developed a new 5-point grading scale, with the PCoA-P1 score ranging from 0 to 4 based on magnetic resonance angiography, in which primary collaterals were dichotomized into good (2-4 points) and poor (0 or 1 point). Stroke recurrences after the index stroke were recorded. Patients who did not experience stroke recurrence were compared with those who experienced single or multiple stroke recurrences.
Results:
From January 2012 to December 2019, 176 patients were enrolled, of which 116 (65.9%) had no stroke recurrence, 35 (19.9%) had a single stroke recurrence, and 25 (14.2%) had multiple stroke recurrences. Patients with single stroke recurrence (odds ratio [OR]=4.134, 95% confidence interval [CI]=1.822-9.380, p=0.001) and multiple stroke recurrences (OR=6.894, 95% CI=2.489-19.092, p<0.001) were more likely to have poor primary collaterals than those with no stroke recurrence.
Conclusions:
The new PCoA-P1 score appears to provide improve predictions of stroke recurrence in patients with IVBAS.
