Prognostic Value of Collateral Assessment in Acute Large-Core Infarction after Endovascular Thrombectomy

Area of Science:

• Neurology
• Interventional Radiology
• Medical Imaging

Background:

• Functional outcomes after endovascular thrombectomy (EVT) for acute large-core infarction are unpredictable.
• Collateral status is a crucial imaging biomarker, but its prognostic significance in this patient group requires further investigation.
• Comparing computed tomography angiography (CTA)-based and digital subtraction angiography (DSA)-based collateral assessment is essential for refining prognostic models.

Purpose of the Study:

• To compare the prognostic value of CTA-based (Tan score) and DSA-based (ASITN/SIR grade) collateral assessment in patients with acute large-core infarction undergoing EVT.
• To determine if CTA-based collateral assessment is a reliable predictor of functional outcomes.

Main Methods:

• A post hoc analysis of a prospective multicenter registry.
• Included patients with acute anterior-circulation large-core infarction (ASPECTS 0-5) who underwent EVT.
• Assessed collateral status using the CTA-based Tan score and DSA-based ASITN/SIR grade.
• Primary outcome: favorable functional outcome (modified Rankin Scale score 0-3 at 90 days).

Main Results:

• Both Tan score and ASITN/SIR grade independently predicted functional outcomes at 90 days.
• CTA-based Tan score (AUC 0.703) and DSA-based ASITN/SIR grade (AUC 0.684) showed comparable prognostic accuracy.
• Combining both scoring systems demonstrated superior predictive performance (AUC 0.747) compared to either alone.

Conclusions:

• CTA-based collateral assessment provides prognostic value comparable to the DSA-based gold standard in acute large-core infarction.
• These findings support the use of CTA for collateral assessment in EVT planning and outcome prediction.
• Combining CTA and DSA collateral assessments may offer enhanced predictive accuracy.