Time Since Stroke Onset, Quantitative Collateral Score, and Functional Outcome After Endovascular Treatment for Acute Ischemic Stroke

Venema, Simone M. Uniken; Wolff, Lennard; Berg, Sophie A. van den; Reinink, Hendrik; Luijten, Sven P.R.; Lingsma, Hester F.; Marquering, Henk A.; Boers, Anna M. M.; Bot, Joost; Hammer, Sebastiaan; Nederkoorn, Paul J.; Roos, Yvo B.W.E.M.; Majoie, Charles B. L. M.; Dankbaar, Jan Willem; Lugt, Aad van der; Worp, H Bart van der

doi:10.1212/wnl.0000000000200968

Cited by 10 publications

(9 citation statements)

References 37 publications

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“…Our study also confirmed that patients with AIS having good collaterals would have lesser neurological impairment, which was in line with many previous studies ( Berkhemer et al, 2016 ; Anadani et al, 2021 ; Uniken Venema et al, 2022 ). And a patient with a qCS (M3-distal) of < 88.29% would be predicted to have an ominous prognosis, with a cutoff higher than the cutoff vCS (50%) ( Lu et al, 2019 ), even if the tissue perfusion parameters met the criteria for MT.…”

Section: Discussionsupporting

confidence: 93%

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Quantitative collateral score for the prediction of clinical outcomes in stroke patients: Better than visual grading

Zhang²,

Cao³

et al. 2022

Front. Neurosci.

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ObjectivesTo identify preoperative prognostic factors for acute ischemic stroke (AIS) patients receiving mechanical thrombectomy (MT) and compare the performance of quantitative collateral score (qCS) and visual collateral score (vCS) in outcome prediction.MethodsFifty-five patients with AIS receiving MT were retrospectively enrolled. qCS was defined as the percentage of the volume of collaterals of both hemispheres. Based on the dichotomous outcome assessed using a 90-day modified Rankin Scale (mRS), we compared qCS, vCS, age, sex, National Institute of Health stroke scale score, etiological subtype, platelet count, international normalized ratio, glucose levels, and low-density lipoprotein cholesterol (LDL-C) levels between favorable and unfavorable outcome groups. Logistic regression analysis was performed to determine the effect on the clinical outcome. The discriminatory power of qCS, vCS, and their combination with cofounders for determining favorable outcomes was tested with the area under the receiver-operating characteristic curve (AUC).ResultsvCS, qCS, LDL-C, and age could all predict clinical outcomes. qCS is superior over vCS in predicting favorable outcomes with a relatively higher AUC value (qCS vs. vCS: 0.81 vs. 0.74) and a higher sensitivity rate (qCS vs. vCS: 72.7% vs. 40.9%). The prediction power of qCS + LDL-C + age was best with an AUC value of 0.91, but the accuracy was just increased slightly compared to that of qCS alone.ConclusionCollateral scores, LDL-C and age were independent prognostic predictors for patients with AIS receiving MT; qCS was a better predictor than vCS. Furthermore, qCS + LDL-C + age offers a strong prognostic prediction power and qCS alone was another good choice for predicting clinical outcome.

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Section: Discussionsupporting

confidence: 93%

“…The adjusted OR value (3.36) of vCS in this study was relatively too large, as 1 point increase in vCS corresponded to a 236% better outcome of patients with AIS. The large span, also found in a recent study ( Uniken Venema et al, 2022 ), reinforced the point that vCS was inferior to qCS due to its unrefined categorical method.…”

Section: Discussionsupporting

confidence: 74%

Quantitative collateral score for the prediction of clinical outcomes in stroke patients: Better than visual grading

Zhang²,

Cao³

et al. 2022

Front. Neurosci.

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“…We found statistically and clinically significant benefit in functional outcomes and mortality with faster IVT administration before EVT. In concert with previous studies, 5–8 our results demonstrate that faster EVT treatment is associated with more home time and lower mortality during the 1-year follow-up period. Our overall results indicate that IVT-to-EVT times may have a modest association with home time, after controlling for patient and hospital factors.…”

Section: Discussionsupporting

confidence: 89%

“…40 For patients who have EVT within 6.5 hours from stroke onset, the benefit of a shorter time to recanalization is independent of baseline collateral status. 6 The present study only included patients with EVT started within 7 hours of stroke onset in which perfusion imaging was not recommended. However, some patients might still have been selected on the basis of advance imaging.…”

Section: Discussionmentioning

confidence: 99%

“…ntravenous thrombolytic therapy (IVT) and endovascular thrombectomy (EVT) improve the outcomes of acute ischemic stroke, but the benefits are timedependent. [1][2][3][4][5][6][7][8] Therefore, door-to-needle (DTN) time has become a target of local and national quality initiatives because DTN time is under the complete control of the hospital care team. 9 Studies have demonstrated that shorter DTN times are associated with better out-comes at discharge and lower 1-year mortality and readmission.…”

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confidence: 99%

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Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke

et al. 2023

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BACKGROUND: Existing data and clinical trials could not determine whether faster intravenous thrombolytic therapy (IVT) translates into better long-term functional outcomes after acute ischemic stroke among those treated with endovascular thrombectomy (EVT). Patient-level national data can provide the required large population to study the associations between earlier IVT, versus later, with longitudinal functional outcomes and mortality in patients receiving IVT+EVT combined treatment. METHODS: This cohort study included older US patients (age ≥65 years) who received IVT within 4.5 hours or EVT within 7 hours after acute ischemic stroke using the linked 2015 to 2018 Get With The Guidelines–Stroke and Medicare database (38 913 treated with IVT only and 3946 with IVT+EVT). Primary outcome was home time, a patient-prioritized functional outcome. Secondary outcomes included all-cause mortality in 1 year. Multivariate logistic regression and Cox proportional hazards models were used to evaluate the associations between door-to-needle (DTN) times and outcomes. RESULTS: Among patients treated with IVT+EVT, after adjusting for patient and hospital factors, including onset-to-EVT times, each 15-minute increase in DTN times for IVT was associated with significantly higher odds of zero home time in a year (never discharged to home) (adjusted odds ratio, 1.12 [95% CI, 1.06–1.19]), less home time among those discharged to home (adjusted odds ratio, 0.93 per 1% of 365 days [95% CI, 0.89–0.98]), and higher all-cause mortality (adjusted hazard ratio, 1.07 [95% CI, 1.02–1.11]). These associations were also statistically significant among patients treated with IVT but at a modest degree (adjusted odds ratio, 1.04 for zero home time, 0.96 per 1% home time for those discharged to home, and adjusted hazard ratio 1.03 for mortality). In the secondary analysis where the IVT+EVT group was compared with 3704 patients treated with EVT only, shorter DTN times (≤60, 45, and 30 minutes) achieved incrementally more home time in a year, and more modified Rankin Scale 0 to 2 at discharge (22.3%, 23.4%, and 25.0%, respectively) versus EVT only (16.4%, P <0.001 for each). The benefit dissipated with DTN>60 minutes. CONCLUSIONS: Among older patients with stroke treated with either IVT only or IVT+EVT, shorter DTN times are associated with better long-term functional outcomes and lower mortality. These findings support further efforts to accelerate thrombolytic administration in all eligible patients, including EVT candidates.

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MRI-based Quantitative Collateral Assessment in Acute Stroke

Polkowski,

Helwig,

Wagner

et al. 2024

Clin Neuroradiol

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Purpose In acute ischemic stroke with large-vessel occlusion (LVO), collateral assessment with single-phase computed tomography angiography (CTA) might underestimate pial collateral supply in a considerable proportion of patients. We aimed to compare time-resolved magnetic resonance imaging (MRI)-based quantitative collateral mapping to conventional collateral imaging with CTA. Methods This retrospective single-center study covering a period of 6 years (2012–2018) included drip-and-ship LVO patients who underwent MR imaging after initial imaging evaluation with CT. For MRI-based collateral assessment, T2*-weighted time series from perfusion-weighted imaging (PWI) were processed to compute a quantitative collateral vessel index (CVIPWI) based on the magnitude of signal variance across the entire acquisition time. CTA-based collateral scores (Tan and Maas) and CVIPWI were investigated in terms of inter-modality associations between collateral measures, as well as their relationships with stroke severity, infarct volume and early functional outcome. Results The final analysis included n = 56 patients (n = 31 female, mean age 69.9 ± 14.21 years). No significant relationship was found between MR-based quantitative collateral supply (CVIPWI) and CT-based collateral scores (r = −0.00057, p = 0.502 and r = −0.124, p = 0.797). In contrast to CVIPWI, CTA-based collateral scores showed no significant relationship with clinical stroke severity and infarct volume. While MR-based CVIPWI was independently associated with favorable early functional outcome in multivariate analysis (OR 1.075, 95% CI 1.001–1.153, p = 0.046), CTA-based collateral scores were not significantly associated with outcome. Conclusions Since collateral scores based on single-phase CTA do not accurately reflect infarct progression and might underestimate pial collateralization in a relevant proportion of patients, they are not associated with early functional outcome in LVO patients. In contrast, CVIPWI represents a robust imaging parameter of collateral supply and is independently associated with functional outcome.

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Time Since Stroke Onset, Quantitative Collateral Score, and Functional Outcome After Endovascular Treatment for Acute Ischemic Stroke

Cited by 10 publications

References 37 publications

Quantitative collateral score for the prediction of clinical outcomes in stroke patients: Better than visual grading

Quantitative collateral score for the prediction of clinical outcomes in stroke patients: Better than visual grading

Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke

MRI-based Quantitative Collateral Assessment in Acute Stroke

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