CT Angiography of Collateral Vessels and Outcomes in Endovascular-Treated Acute Ischemic Stroke Patients

Abstract

Background and PurposeMeasuring the extent of the collateral blood vessels using computed tomography (CT) angiography source images may promote tissue survival and functional gain in acute ischemic stroke patients who are candidates for endovascular recanalization treatment.MethodsOf 5,558 acute stroke patients registered in a prospective clinical stroke registry, 104 met the selection criteria of endovascular recanalization treatment for internal cerebral artery or middle cerebral artery main-stem (M1) occlusions and presented for treatment ≤4 hours after the event. Using CT angiography source images, two independent and blinded reviewers measured the extent of collateral circulations at four regions, with good interrater reliability. The functional recovery at 3 months after stroke was used as an outcome variable.ResultsCases with a sufficient collateral circulation at the Sylvian fissure showed significantly increased likelihood of having a modified Rankin Scale score of ≤2 at 3 months after stroke (adjusted odds ratio=3.03, 95% confidence interval=1.19–7.73, p=0.02), but the association became nonsignificant after adding the infarct volume to the model (p=0.65). The association between leptomeningeal convexity collaterals and functional recovery was no longer significant after adjusting for the infarct volume (p=0.28). The natural indirect effect of infarct volume on functional recovery was significant for both the Sylvian fissure (p=0.03) and leptomeningeal convexity (p=0.02) collaterals.ConclusionsThe extent of collateral circulation at the Sylvian fissure was significantly associated with functional recovery, which may be mediated via the volume of the final infarction.

Comparison of Solitaire-FR and Trevo-ProVue Thrombectomy in Patients with Anterior Circulation Large Artery Occlusion

“…The good collateral was the only significant factor in good outcome at 3 months. The sufficient baseline collateral status in acute ischemic stroke patients was associated with improved functional recovery and decreased mortality rate at 3 months after stroke (15). Our study showed similar results that collaterals are important for the clinical outcome of acute ischemic stroke patients.…”

Utility of Leptomeningeal Collaterals in Predicting Intracranial Atherosclerosis-Related Large Vessel Occlusion in Endovascular Treatment

“…However, there has been no consensual grading system established to evaluate leptomeningeal collaterals on CTA. To avoid arbitrary grading, we tried to choose collateral assessment methods that have all been widely used in previous studies [ 21 , 22 ]. Based on the consistent findings from those collateral assessment methods, we regrouped the leptomeningeal collaterals by its cutoff value into incomplete or complete.…”

Low Hypoperfusion Intensity Ratio Is Associated with a Favorable Outcome Even in Large Ischemic Core and Delayed Recanalization Time

“…Collateral status is a commonly used method that reflects hypoperfusion severity. Robust collateral flow is associated with smaller ischemic core lesions and slower progression, which may lead to improved clinical outcomes [ 1 , 2 , 3 , 4 ]. Moreover, time windows for EVT eligibility can be determined based on the collateral status.…”