CT Angiography Clot Burden Score and Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute Middle Cerebral Artery Infarct

Tan, Isabel; Demchuk, Andrew M.; Hopyan, Julia; Zhang, L.; Gladstone, David J.; Wong, Kwok-Kin; Martín, M. Carmen; Symons, Sean; Fox, Allan J.; Aviv, Richard I.

doi:10.3174/ajnr.a1408

Cited by 622 publications

(557 citation statements)

References 43 publications

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“…1,7,18,25,26 However, very few studies have evaluated both radiologic and clinical factors in the context of CMR. Von Kummer et al 12 showed that a good clinical outcome was more likely in the presence of more distal occlusions, good baseline function, and angiographic recanalization within 24 hours of treatment with IA or IV thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

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Factors Influencing Clinically Meaningful Recanalization after IV-rtPA in Acute Ischemic Stroke

Murphy

Symons²,

Hopyan

et al. 2012

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

“…CBS assigns 10 points to normal ipsilateral vasculature and subtracts points depending on clot location and distribution. 17,18 Two points each are deducted for the supraclinoid ICA segment, proximal MCA, and distal MCA. Infraclinoid ICA, anterior cerebral artery, and the M2 segment of the MCA are each assigned 1 point.…”

Section: Radiologic Parametersmentioning

confidence: 99%

Factors Influencing Clinically Meaningful Recanalization after IV-rtPA in Acute Ischemic Stroke

Murphy

Symons²,

Hopyan

et al. 2012

AJNR Am J Neuroradiol

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“…As a result, 4D-CTA should also be a stronger predictor of patient outcome after stroke. 51 In a prospective cohort study in 40 subjects, Smit et al 22 compared CTA with TI-CTA calculated from 4D-CTA data in patients presenting with ischemic stroke. Patients with poor collateral circulation on conventional CTA were still found to have good clinical outcome in 31% of cases.…”

Section: Classification Of Arteriovenous Malformations and Arteriovenmentioning

confidence: 99%

4D-CTA in Neurovascular Disease: A Review

Kortman

Smit

Oei

et al. 2014

AJNR Am J Neuroradiol

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SUMMARY:CT angiography is a widely used technique for the noninvasive evaluation of neurovascular pathology. Because CTA is a snapshot of arterial contrast enhancement, information on flow dynamics is limited. Dynamic CTA techniques, also referred to as 4D-CTA, have become available for clinical practice in recent years. This article provides a description of 4D-CTA techniques and a review of the available literature on the application of 4D-CTA for the evaluation of intracranial vascular malformations and hemorrhagic and ischemic stroke. Most of the research performed to date consists of observational cohort studies or descriptive case series. These studies show that intracranial vascular malformations can be adequately depicted and classified by 4D-CTA, with DSA as the reference standard. In ischemic stroke, 4D-CTA better estimates thrombus burden and the presence of collateral vessels than conventional CTA. In intracranial hemorrhage, 4D-CTA improves the detection of the "spot" sign, which represents active ongoing bleeding.ABBREVIATIONS: dAVF ϭ dural arteriovenous fistula; TI-CTA ϭ timing-invariant CTA

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“…A 3-grade score (1 = high, 2 = middle, 3 = low) as defined by Knauth et al [20,21] and further refined by CTA post-processing techniques [22] was used as a reference for the evaluation of collaterals. The scale was defined as: (1) contrast filling being visible from pial collaterals to the M1 segment in CTA and DSA, (2) contrast filling being visible from the periphery to M2 branches in CTA and DSA, (3) only peripheral vascular structures show contrast filling.…”

Section: Collateralizationmentioning

confidence: 99%

CTP-Based Tissue Outcome: Promising Tool to Prove the Beneficial Effect of Mechanical Recanalization in Acute Ischemic Stroke

Drewer-Gutland

Kemmling

Ligges³

et al. 2015

Fortschr Röntgenstr

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Hintergrund: Zur Überprüfung des gewebsprotektiven Effekts der mechanischen Rekanalisation, untersuchten wir das CTP-basierende Gewebe Outcome ("GO") und korrelierten diesen Parameter mit dem 3-Monats klinischen Outcome ("KO"). Material und Methoden: 159 Patienten mit zerebralen Gefäßverschlüssen wurden mittels CCT, CT-Angiografie (CTA) und CT-Perfusion (CTP) untersucht und anschließend mechanisch rekanalisiert. Für das finale Infarktvolumen wurde ein natives CCT nach 24 Std. angefertigt. Das "GO" ("Prozentualer Mismatch Loss" = %ML) wurde als Differenz zwischen initialer Penumbra des CTP und finalem Infarktvolumen im Kontroll-CCT definiert. Das 3-Monats "modified-Rankin-Scale" (mRS), Alter, Auftreten von Blutungen, Rekanalisationszeit, TICI-Score, Kollateralstatus, Infarktzunahme und finales Infarktvolumen wurden bestimmt. Mithilfe des Spearman's Korrelationskoeffizienten und der nominalen Regressionsanalyse überprüften wir den Einfluss dieser Parameter auf das mRS. Ergebnisse: Signifikante Korrelationen mit dem mRS bestehen für die Parameter %ML (c = 0,48, p < 0,001), finales Infarktvolumen (c = 0,52, p < 0,001), TICI score (c = -0,35, p < 0,001), initialer Infarktkern (c = 0,14, p = 0,039) und Alter (c = 0,37, p < 0,001). In der Regressionsanalyse konnte %ML die mRS-Klassifikation zu 38,5 % korrekt vorhersagen; die Subklassen mRS 1 oder 6 konnten zu 86,4 % bzw. 60,9 % vorhergesagt werden. Es konnten keine Korrelationen mit mRS für die Parameter Rekanalisationszeit, Kollateralstatus und Auftreten von Blutungen festgestellt werden. Schlussfolgerung: Das CT-basierte GO beschreibt besser als der TICI-Score den klinischen Erfolg der mechanischen Rekanalisation, so dass nicht die ReAbstract ! Purpose: To prove the tissue-protecting effect of mechanical recanalization, we assessed the CT perfusion-based tissue outcome ("TO") and correlated this imaging parameter with the 3-month clinical outcome ("CO"). Materials and Methods: 159 patients with large intracranial artery occlusions revealing mechanical recanalization were investigated by CCT, CT angiography (CTA) and CT perfusion (CTP) upon admission. For the final infarct volume, native CCT was repeated after 24 h. The "TO" ("percentage mismatch loss" = %ML) was defined as the difference between initial penumbral tissue on CTP and final infarct volume on follow-up CCT. We monitored the three-month modified Rankin Scale (mRS), age, bleeding occurrence, time to recanalization, TICI score and collateralization grade, infarct growth and final infarct volume. Spearman's correlation and nominal regression analysis were used to evaluate the impact of these parameters on mRS. Results: Significant correlations were found for % ML and mRS (c = 0.48, p < 0.001), for final infarct volume and mRS (c = 0.52, p < 0.001), for TICI score and mRS (c = -0.35, p < 0.001), for initial infarct core and mRS (c = 0.14, p = 0.039) as well as for age and mRS (c = 0.37, p < 0.001). According to the regression analysis, %ML predicted the classification of mRS correctly in 38.5 % of cases. The s...

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CT Angiography Clot Burden Score and Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute Middle Cerebral Artery Infarct

Cited by 622 publications

References 43 publications

Factors Influencing Clinically Meaningful Recanalization after IV-rtPA in Acute Ischemic Stroke

Factors Influencing Clinically Meaningful Recanalization after IV-rtPA in Acute Ischemic Stroke

4D-CTA in Neurovascular Disease: A Review

CTP-Based Tissue Outcome: Promising Tool to Prove the Beneficial Effect of Mechanical Recanalization in Acute Ischemic Stroke

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