Differentiating effective salvage from ineffective delayed compensation in anterior circulation stroke: a dynamic...

Area of Science:

• Neuroimaging
• Cerebrovascular disease
• Stroke imaging

Background:

• Acute large vessel occlusion (LVO) stroke requires rapid assessment of collateral circulation for treatment decisions.
• Current collateral assessment methods can be subjective or computationally intensive.
• Objective, deconvolution-free methods are needed for accurate hemodynamic assessment.

Purpose of the Study:

• To investigate a deconvolution-free Dynamic Quantitative Collateral Approach using 4D-CTA from CTP source data.
• To evaluate its prognostic value for Early Neurological Recovery (ENR) in acute anterior circulation LVO.
• To differentiate effective tissue salvage from ineffective delayed perfusion.

Main Methods:

• Retrospective analysis of 94 anterior circulation LVO patients.
• Calculation of Rapid Compensation Index (RCI), Late Compensation Index (LCI), and Total Compensation Index (TCI) from Vessel Volume Deficit (VVD) on 4D-CTA.
• Comparison of quantitative indices against visual scores (Tan, rLMC, Menon) using logistic regression and ROC analysis.

Main Results:

• TCI independently predicted ENR with high discrimination (AUC=0.858), outperforming the Tan score.
• TCI showed comparable performance to the Menon score and superior model fit (AIC=92.02).
• TCI correlated strongly with infarct core volume (ρ=-0.85) and demonstrated clinical utility via a nomogram.

Conclusions:

• The dynamic quantitative collateral approach provides objective, deconvolution-free hemodynamic assessment.
• It accurately predicts ENR in acute LVO stroke, distinguishing functional reperfusion from delayed compensation.
• This method offers a robust tool for acute stroke triage, comparable to expert consensus.