Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome
Ahmet Yabalak1, Muhammed Nur Ögün2, Ayşenur Önalan3
1Duzce University, Faculty of Medicine, Department of Neurology, Duzce, Türkiye.
Insights
The multiphase CT angiography (mCTA) and regional leptomeningeal collateral (rLMC) scores best predict outcomes after stroke treatment. Further research could combine their strengths for improved stroke prognosis assessment.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Collateral circulation significantly impacts prognosis in anterior circulation stroke patients undergoing endovascular treatment.
- Numerous studies have explored this relationship, yet a consensus on the best predictive scoring remains elusive.
Purpose of the Study:
- To compare the predictive capabilities of five commonly used collateral scores for clinical outcomes in stroke patients.
- To identify which collateral scoring methods offer the most accurate prognosis following endovascular therapy.
Main Methods:
- Retrospective analysis of 68 patients with anterior circulation stroke treated between November 2019 and December 2021.
- Inclusion criteria: premorbid modified Rankin Scale (mRS) < 3, intracranial internal carotid artery and/or middle cerebral artery M1 occlusion, and pre-procedural multiphase CT angiography (mCTA).
- Evaluation of five collateral scores: mCTA, Tan, Maas, Miteff, and regional leptomeningeal collateral (rLMC), correlating them with 3-month clinical outcomes (mRS).
Main Results:
- Good clinical outcomes (mRS ≤ 2) were observed in 37 out of 68 patients at 3 months.
- Only the mCTA and rLMC scores were significantly higher in patients with good outcomes.
- Both mCTA and rLMC scores showed a significant correlation with the 3-month mRS, but neither was an independent predictor of prognosis.
Conclusions:
- The mCTA and rLMC collateral scores demonstrated the highest predictive power and correlation with 3-month clinical outcomes.
- The findings suggest the potential benefit of developing a novel scoring system that integrates regional and temporal evaluation from mCTA for improved stroke prognosis.
Background:
The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies.
Objective:
In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used.
Methods:
Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated.
Results:
Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS ≤ 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis.
Conclusion:
mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.
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