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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Published on: January 18, 2018

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MR Angiography in Assessment of Collaterals in Patients with Acute Ischemic Stroke: A Comparative Analysis with

Brian Tsui1, May Nour1,2, Iris Chen1

  • 1Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.

Brain Sciences
|September 23, 2022
PubMed

Insights

Assessing collateral status in acute ischemic stroke (AIS) patients using pretreatment MRA shows poor agreement with digital subtraction angiography (DSA). Current MRA scoring systems like Tan and Maas are not reliable for grading collaterals in AIS.

Area of Science:

  • Neuroradiology
  • Vascular Neurology
  • Medical Imaging

Background:

  • Collateral status is crucial for prognosis and treatment decisions in acute ischemic stroke (AIS).
  • Grading collaterals on Magnetic Resonance Angiography (MRA) is less studied compared to Computed Tomography Angiography (CTA).
  • Accurate collateral assessment on MRA is needed to guide endovascular treatment in AIS.

Purpose of the Study:

  • To evaluate the accuracy of pretreatment MRA in assessing collateral status in AIS patients.
  • To compare MRA collateral grading using Tan and Maas scores against digital subtraction angiography (DSA) as the reference standard.
  • To determine the inter-rater reliability of MRA collateral scoring systems.

Main Methods:

  • Retrospective analysis of 104 AIS patients with anterior circulation proximal arterial occlusion, baseline MRA, and subsequent endovascular treatment.
  • Independent collateral assessment by two neuroradiologists using the Tan and Maas scoring systems on MRA.
  • DSA was used as the reference standard for collateral grading using the American Society of Interventional and Therapeutic Neuroradiology system.

Main Results:

  • Inter-rater agreement for MRA collateral scoring was moderate (Tan score: k=0.49; Maas score: k=0.44).
  • DSA identified 47% sufficient and 53% insufficient collaterals.
  • Both Tan and Maas scores showed poor agreement with DSA (Tan: 0.09; Maas: 0.03), with limited accuracy in identifying sufficient collaterals.

Conclusions:

  • Pretreatment MRA demonstrates limited concordance with DSA for grading collateral status in AIS patients.
  • The Tan and Maas scoring systems show poor reliability for collateral assessment on MRA in this cohort.
  • Further research is needed to develop and validate reliable MRA-based collateral assessment methods for AIS management.

Keywords:
MRIcollateralsstroke

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