The Cortical Vein Opacification Score (COVES) Is Independently Associated with DSA ASITN Collateral Score

Pretreatment CTA-based Cortical Vein Opacification Score (COVES) has been shown to predict good functional outcomes at 90 days in patients with acute ischemic stroke secondary to large vessel occlusion (AIS-LVO). This is thought to be related to its ability to measure collateral status (CS). However, its association with the reference standard test, the DSA-based American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score, has yet to be established. Therefore, this study assesses the relationship between COVES and ASITN CS.

In this prospectively collected, retrospectively reviewed analysis, patients with anterior circulation LVO from September 1, 2017, to October 1, 2023, were included. The COVES grading, which ranges from 0 to 6, was independently assessed by 2 board-certified neuroradiologists. The ASITN CS was independently assessed by a board-certified neuroradiologist and the performing neurointerventionalist. Any discrepancies were resolved through consensus review. Spearman rank correlation, univariable logistic regression, multivariable logistic regression, and receiver operating characteristic curve analysis were performed. A P value of ≤ .05 was considered significant.

In total, 311 consecutive patients (median, IQR = 68 years [59-78 years]; 55.9% women) met our inclusion criteria. There was significant positive correlation between COVES and ASITN CS (ρ = 0.41, P < .001), and higher COVES was significantly and independently associated with good ASITN CS (unadjusted-OR = 1.74, P < .001) and adjusted-OR = 1.73, P < .001). Receiver operating characteristic curve analysis showed area under the curve of 0.71, P < .001).

By demonstrating the independent association of COVES with the reference standard test for collateral status assessment, the ASITN CS, we further validate the role of COVES in estimating collateral status.