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Composite arterial and venous collateral score on single-phase CTA predicts 90-day outcomes in anterior circulation
Hamza Adel Salim1,2, Dhairya A Lakhani2,3, Janet Mei2
1Department of Neuroradiology, MD Anderson Medical Center, Houston, Texas, USA hamza.sleeem@gmail.com vyedava1@jhmi.edu.
Insights
A new CTA Collateral Impairment Score (CCIS) combining arterial and venous assessments accurately predicts stroke outcomes. Higher CCIS scores correlate with poorer functional outcomes and increased mortality in acute ischemic stroke patients.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Collateral circulation is crucial for acute ischemic stroke outcomes.
- Arterial and venous collateral assessments on CTA have prognostic value but are typically analyzed separately.
- Previous methods lacked a unified approach to evaluating combined arterial and venous collateral status.
Purpose of the Study:
- To develop and validate the CTA Collateral Impairment Score (CCIS), a composite measure of arterial and venous collaterals.
- To investigate the association between CCIS and 90-day functional outcomes in anterior circulation large-vessel occlusion (LVO) stroke.
- To assess CCIS's predictive performance compared to existing stroke imaging scores.
Main Methods:
- Retrospective cohort study of 1080 patients with anterior circulation LVO stroke.
- Development of CCIS by combining Tan (arterial) and Cortical Venous Opacification Score (COVES) (venous) scores.
- Analysis of CCIS association with modified Rankin Scale (mRS) scores and mortality at 90 days.
Main Results:
- Favorable outcomes (mRS 0-2) decreased significantly with increasing CCIS (66% for CCIS 0, 32% for CCIS 1, 17% for CCIS 2).
- Mortality rates increased with higher CCIS (11% for CCIS 0, 25% for CCIS 1, 36% for CCIS 2).
- CCIS demonstrated strong independent predictive value for both favorable outcomes and mortality, outperforming ASPECTS.
Conclusions:
- The CCIS is a robust, composite imaging biomarker for predicting 90-day outcomes in acute ischemic stroke.
- Integrating CCIS into acute stroke imaging can enhance risk stratification and inform treatment decisions.
- This novel score offers a more comprehensive assessment of collateral status than individual arterial or venous evaluations.
Background:
Collateral circulation influences clinical outcomes in patients with acute ischemic stroke due to anterior circulation large-vessel occlusion (LVO). While both arterial and venous collateral assessments on single-phase computed tomography angiography (CTA) have prognostic value, they have traditionally been evaluated independently.
Purpose:
We developed the CTA Collateral Impairment Score (CCIS), a composite measure incorporating arterial (Tan) and venous (Cortical Venous Opacification Score (COVES)) scores, and investigated its association with 90-day functional outcomes.
Materials And Methods:
We conducted a retrospective cohort study including 1080 patients with anterior circulation LVO stroke across four comprehensive stroke centers. Patients were assigned a CCIS of 0 (preserved), 1 (moderate impairment), or 2 (severe impairment) based on predefined thresholds for Tan and COVES scores.
Results:
Favorable outcomes (modified Rankin Scale (mRS) score 0-2) occurred in 66% of patients with CCIS 0, 32% with CCIS 1, and 17% with CCIS 2 (P<0.001). Mortality increased with higher CCIS (11%, 25%, and 36% for CCIS 0, 1, and 2 respectively; P<0.001). In multivariable models, CCIS 0 and 1 were independently associated with greater odds of favorable outcomes compared with CCIS 2 (adjusted odds ratio (aOR) 5.77 (95% confidence interval (CI), 3.78 to 8.82) and 1.72 (95% CI, 1.14 to 2.60), respectively). CCIS also predicted mortality (aOR for CCIS 0 vs 2: 0.39 (95% CI, 0.25 to 0.61); P<0.001). The predictive performance of CCIS (area under the curve (AUC) 0.73) exceeded that of the Alberta Stroke Program Early CT Score (ASPECTS) and occlusion site and approximated National Institutes of Health Stroke Scale (NIHSS); inclusion of CCIS improved multivariable model discrimination (AUC 0.84).
Conclusion:
CCIS, a composite arterial and venous collateral score derived from single-phase CTA, was strongly and independently associated with 90-day outcomes in anterior circulation LVO stroke. Its integration into acute stroke imaging assessment may improve risk stratification and guide therapeutic decisions.
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