Systematic Review of Methods for Assessing Leptomeningeal Collateral Flow

McVerry, Ferghal; Liebeskind, David S; Muir, Keith W.

doi:10.3174/ajnr.a2794

Cited by 194 publications

(173 citation statements)

References 79 publications

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“…2012), and has recently been confirmed for stroke patients treated with EVT (Galimanis et al. 2012; Nambiar et al.…”

Section: Discussionmentioning

confidence: 76%

“…Pial collaterals have been recognized as a prognostic factor for favorable clinical outcome in ischemic stroke patients (Liebeskind 2003; McVerry et al. 2012), as they can temporarily compensate regional ischemia to a level that allows tissue survival (Astrup et al. 1979).…”

Section: Introductionmentioning

confidence: 99%

“…2003), no generally accepted grading system exists so far for the assessment of collaterals on CTA (McVerry et al. 2012). …”

Section: Introductionmentioning

confidence: 99%

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Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

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PurposeClinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.MethodsIn our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT‐CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data‐driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.ResultsSuccessful angiographic reperfusion (OR 26.50; 95%‐CI 9.33–83.61) and good collaterals (OR 9.69; 95%‐CI 2.28–59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%‐CI 0.14–0.85), younger age (OR 0.88; 95%‐CI 0.83–0.92) and higher NCCT ASPECTS (OR 2.54; 95%‐CI 1.01–6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.Conclusions CTA‐collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA‐collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA‐collaterals.

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“…2012), and has recently been confirmed for stroke patients treated with EVT (Galimanis et al. 2012; Nambiar et al.…”

Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

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Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

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“…34 Thus, there is a need for noninvasive methods that can measure and grade the flow in specific intracranial arteries and describe the interaction of flow between different collateral systems. 35 By measuring at multiple sites, as in this study, the flow and division of blood into proximal and distal branches of the cerebral vascular tree could be described. An unbalanced arterial BFR pattern together with a normal cerebral Since tCBF is strongly related to age and brain volume, we prefer to report flow in cerebral arteries as proportions of tCBF ( Figure 4A).…”

Section: Blood Flow Distribution-the Collateral Circulationmentioning

confidence: 95%

Blood Flow Distribution in Cerebral Arteries

Zarrinkoob

Ambarki

Wåhlin

et al. 2015

J Cereb Blood Flow Metab

273

217

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High-resolution phase-contrast magnetic resonance imaging can now assess flow in proximal and distal cerebral arteries. The aim of this study was to describe how total cerebral blood flow (tCBF) is distributed into the vascular tree with regard to age, sex and anatomic variations. Forty-nine healthy young (mean 25 years) and 45 elderly (mean 71 years) individuals were included. Blood flow rate (BFR) in 21 intra-and extracerebral arteries was measured. Total cerebral blood flow was defined as BFR in the internal carotid plus vertebral arteries and mean cerebral perfusion as tCBF/brain volume. Carotid/vertebral distribution was 72%/28% and was not related to age, sex, or brain volume. Total cerebral blood flow (717 ± 123 mL/min) was distributed to each side as follows: middle cerebral artery (MCA), 21%; distal MCA, 6%; anterior cerebral artery (ACA), 12%, distal ACA, 4%; ophthalmic artery, 2%; posterior cerebral artery (PCA), 8%; and 20% to basilar artery. Deviating distributions were observed in subjects with 'fetal' PCA. Blood flow rate in cerebral arteries decreased with increasing age (P o 0.05) but not in extracerebral arteries. Mean cerebral perfusion was higher in women (women: 61 ± 8; men: 55 ± 6 mL/min/100 mL, P o 0.001). The study describes a new method to outline the flow profile of the cerebral vascular tree, including reference values, and should be used for grading the collateral flow system.

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“…4,6,[8][9][10] The latter offers the advantages of short scan times and wide availability. In conventional CTA, however, the assessment of collaterals is heavily dependent on the timing of image acquisition.…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Beyer¹,

Baumgarten

Thierfelder³

et al. 2014

J Cereb Blood Flow Metab

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The velocity of collateral filling can be assessed in dynamic time-resolved computed tomography (CT) angiographies and may predict initial CT perfusion (CTP) and follow-up lesion size. We included all patients with an M1 ± internal carotid artery (ICA) occlusion and follow-up imaging from an existing cohort of 1791 consecutive patients who underwent multimodal CT for suspected stroke. The velocity of collateral filling was quantified using the delay of time-to-peak (TTP) enhancement of the M2 segment distal to the occlusion. Cerebral blood volume (CBV) and mean transit time (MTT)-CBV mismatch were assessed in initial CTP. Follow-up lesion size was assessed by magnetic resonance imaging (MRI) or non-enhanced CT (NECT). Multivariate analyses were performed to adjust for extent of collateralization and type of treatment. Our study comprised 116 patients. Multivariate analysis showed a short collateral blood flow delay to be an independent predictor of a small CBV lesion (P o 0.001) and a large relative mismatch (P o 0.001) on initial CTP, of a small follow-up lesion (P o 0.001), and of a small difference between initial CBV and follow-up lesion size (P = 0.024). Other independent predictors of a small lesion on follow-up were a high morphologic collateral grade (P = 0.001), lack of an additional ICA occlusion (P = 0.009), and intravenous thrombolysis (P = 0.022). Fast filling of collaterals predicts initial CTP and follow-up lesion size and is independent of extent of collateralization.

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Systematic Review of Methods for Assessing Leptomeningeal Collateral Flow

Cited by 194 publications

References 79 publications

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Blood Flow Distribution in Cerebral Arteries

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

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