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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Multiphase CTA Collateral Score to Identify Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion
Jiajie Xia1, Chuanjian Tu, Hui Qian
1From the Department of Neurosurgery, The Central Affiliated Hospital, Shaoxing University, Shaoxing, China.
Insights
The multiphase CT angiography (mCTA) collateral score can help identify intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion (LVO) in acute ischemic stroke (AIS). A higher mCTA score indicates a greater likelihood of ICAS-related LVO.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Imaging
Background:
- Acute ischemic stroke with large vessel occlusion (AIS-LVO) requires timely revascularization.
- Cerebral perfusion in intracranial atherosclerotic stenosis (ICAS) is critically dependent on collateral circulation.
Purpose of the Study:
- To evaluate the multiphase CT angiography (mCTA) collateral score as a diagnostic marker for ICAS-related LVO.
- To determine the association between mCTA collateral score and the etiology of AIS-LVO.
Main Methods:
- Retrospective review of 92 patients with AIS-LVO who underwent mCTA.
- Logistic regression and receiver operating characteristic (ROC) analysis to assess the diagnostic accuracy of the mCTA collateral score for ICAS-related LVO.
Main Results:
- Patients with ICAS-related LVO had significantly higher median mCTA collateral scores (4 vs. 3; P<0.0001).
- The mCTA collateral score demonstrated good diagnostic accuracy (AUC=0.817) for identifying ICAS-related LVO, with an optimal cutoff of 3.5.
- Higher mCTA scores (4-5) were associated with worse functional outcomes (higher mRS) at discharge.
Conclusions:
- The mCTA collateral score is a potential marker for identifying ICAS-related LVO in AIS-LVO patients.
- Utilizing the mCTA collateral score may aid in determining stroke etiology and guiding treatment decisions.
Objective:
Identification of acute ischemic stroke with large vessel occlusion (AIS-LVO) etiology is crucial for effective revascularization therapy. As collaterals are pivotal in maintaining cerebral perfusion in intracranial atherosclerotic stenosis (ICAS), we investigated whether multiphase CT angiography (mCTA) collateral score can be a diagnosis marker of ICAS-related LVO.
Methods:
We reviewed clinical and imaging data from 92 patients who presented with AIS-LVO and underwent mCTA (57 ICAS-related LVO and 35 embolic LVO). Logistic regression was used to identify ICAS-related LVO. The diagnostic accuracy of the mCTA collateral score for identifying ICAS-related LVO was determined using receiver operating characteristic (ROC) analysis.
Results:
Compared with patients with embolic LVO, those with ICAS-related LVO had a high median mCTA collateral score (4 vs. 3; P<0.0001). The multinomial logistic regression analysis revealed a significant increase in the mCTA collateral score (OR: 3.717, 95% CI: 2.009-6.876, P<0.0001) in patients with ICAS-related LVO. ROC analysis revealed that the optimal cutoff point of the mCTA collateral score to diagnosis the ICAS-related LVO was 3.5, the area under the curve (AUC) was 0.817 (95% CI: 0.736-0.899; P<0.0001), sensitivity was 80.7%, and specificity was 74.3%. Further analysis revealed that patients with a 4 to 5 mCTA collateral score exhibited a significantly higher median modified Rankin Scale (mRS) at discharge compared with those with a 0 to 3 score (P=0.0464).
Conclusions:
The mCTA collateral score may be associated with ICAS-related LVO and could be beneficial in identifying the etiology of AIS-LVO.
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