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Differentiating effective salvage from ineffective delayed compensation in anterior circulation stroke: a dynamic
Zhong Zheng1, Ailixier Tayier1, Dayu Wu2
1Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China.
Objectives:
To investigate a deconvolution-free Dynamic Quantitative Collateral Approach based on 4D-CTA reconstructed from CTP source data, and to evaluate its prognostic value for Early Neurological Recovery (ENR) in acute anterior circulation large vessel occlusion (LVO) by differentiating effective tissue salvage from ineffective delayed perfusion.
Methods:
In this retrospective study of 94 patients with anterior circulation LVO, the Rapid Compensation Index (RCI), Late Compensation Index (LCI), and Total Compensation Index (TCI) were calculated based on Vessel Volume Deficit (VVD) derived from 4D-CTA reconstructed from CTP source data. Logistic regression, ROC analysis, and Akaike Information Criterion (AIC) were utilized to compare the quantitative collateral indices against visual scores (Tan, rLMC, Menon) for predicting ENR (7-day ΔNIHSS ≥4). A predictive nomogram was constructed and evaluated for clinical net benefit.
Results:
RCI significantly predicted recovery, whereas LCI showed limited utility, objectively reflecting delayed collateral filling. TCI independently predicted ENR with high discrimination (AUC = 0.858), significantly outperforming the Tan score (AUC = 0.810, p = 0.012) and equating to the expert multiphase Menon score (p = 0.313). TCI demonstrated superior model fit (AIC = 92.02) and a strong inverse correlation with infarct core volume (ρ = -0.85). The TCI-integrated nomogram exhibited excellent calibration and clinical net benefit.
Conclusion:
This dynamic approach provides an objective, deconvolution-free assessment of hemodynamic efficiency. By physiologically distinguishing functional reperfusion from ineffective delayed compensation, it demonstrates prognostic accuracy comparable to expert consensus, offering a robust tool for acute stroke triage.
