Utility of digital subtraction angiography‐based collateral evaluation in medically treated acute symptomatic basilar artery stenosis

Lee, W. J.; Jung, Keun‐Hwa; Ryu, Young Jin; Kim, J. M.; Chu, Kon; Kim, Manho; Lee, Sang Kun; Roh, Jae-Kyu

doi:10.1111/ene.13351

Cited by 9 publications

(7 citation statements)

References 26 publications

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“…Better collateral status by such method was associated with a reduced incidence of poor functional outcome (mRS 3–6) at 3 months (OR of 1-score increment in the collateral score, 0.21; 95% CI 0.08 to 0.58; p=0.003). 68 …”

Section: Collateral Circulation and Prognosis Of Ischaemic Strokementioning

confidence: 99%

Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017

et al. 2018

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Collateral circulation plays a vital role in sustaining blood flow to the ischaemic areas in acute, subacute or chronic phases after an ischaemic stroke or transient ischaemic attack. Good collateral circulation has shown protective effects towards a favourable functional outcome and a lower risk of recurrence in stroke attributed to different aetiologies or undergoing medical or endovascular treatment. Over the past decade, the importance of collateral circulation has attracted more attention and is becoming a hot spot for research. However, the diversity in imaging methods and criteria to evaluate collateral circulation has hindered comparisons of findings from different cohorts and further studies in exploring the clinical relevance of collateral circulation and possible methods to enhance collateral flow. The statement is aimed to update currently available evidence and provide evidence-based recommendations regarding grading methods for collateral circulation, its significance in patients with stroke and methods under investigation to improve collateral flow.

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Section: Collateral Circulation and Prognosis Of Ischaemic Strokementioning

confidence: 99%

Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017

et al. 2018

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“…The patients in this article were diagnosed with CCAOD and internal carotid artery steal by DSA. The display of collateral circulation pathways by neck vascular ultrasound was not as clear, intuitive, and accurate as CTA scans of the head and neck [20].…”

Section: Discussionmentioning

confidence: 89%

Head and neck CT angiography to assess the internal carotid artery stealing pathway

Wang

Zheng

et al. 2020

BMC Neurol

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Background: Common carotid artery occlusive disease (CCAOD) could form internal carotid artery steal pathways. Based on the diagnostic results of digital subtraction angiography (DSA), head and neck computed tomography angiography (CTA) was used to find the internal carotid artery stealing pathway after CCAOD. Methods: The clinical and imaging data of 18 patients with CCAOD were retrospectively analyzed. DSA and CTA was used to evaluate internal carotid artery steal pathways. Results: Of the 18 patients with CCAOD, 10 patients found internal carotid artery steal pathways. There were 7 males and 3 females. Vascular ultrasound examination of all patients: The affected side had no blood flow in common carotid artery (CCA), and had retrograde blood flow in the external carotid artery (ECA). The blood flow of the affected side was decreased in the internal carotid artery (ICA), but it was antegrade. DSA diagnosed 10 cases of CCA occlusion and CTA diagnosed 10 cases of CCA occlusion. DSA and CTA found 6 internal carotid artery blood stealing pathways: ① Vertebral artery → occipital artery → external carotid artery → internal carotid artery (6 cases); ② Thyrocervical trunk → ascending cervical artery → occipital artery → external carotid artery → internal carotid artery (7 cases); ③ Costocervical trunk → deep cervical artery → occipital artery → external carotid artery → internal carotid artery (6 cases); ④ Affected side thyroid neck trunk → inferior thyroid artery → superior thyroid artery → external carotid artery → internal carotid artery (2 cases); ⑤ Contralateral external carotid artery → contralateral superior thyroid artery → affected superior thyroid artery → external carotid artery → neck Internal artery (2 cases); ⑥ Parathyroid neck → superficial cervical artery → occipital artery → external carotid artery → internal carotid artery (1 case). Conclusions: The patients with CCAOD can find the internal carotid artery blood stealing pathway through CTA.

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“…However, these scoring systems focus on patients with acute BA occlusion rather than IVBAS. Scoring systems for BA stenosis have been proposed, but they have been used to predict functional outcomes rather than stroke recurrence, 17 18 and there has been no scoring system for predicting stroke recurrence in patients with IVBAS.…”

Section: Discussionmentioning

confidence: 99%

Collateral Flow in Magnetic Resonance Angiography: Prognostic Value for Vertebrobasilar Stenosis With Stroke Recurrence

Yan

Kang

et al. 2022

J Clin Neurol

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Background and Purpose Intracranial vertebrobasilar atherosclerotic stenosis (IVBAS) is a major cause of posterior circulation stroke. Some patients suffer from stroke recurrence despite receiving medical treatment. This study aimed to determine the prognostic value of a new score for the posterior communicating artery and the P1 segment of the posterior cerebral artery (PCoA-P1) for predicting stroke recurrence in IVBAS. Methods We retrospectively enrolled patients with severe IVBAS (70%–99%). According to the number of stroke recurrences, patients were divided into no-recurrence, single-recurrence, and multiple-recurrences groups. We developed a new 5-point grading scale, with the PCoA-P1 score ranging from 0 to 4 based on magnetic resonance angiography, in which primary collaterals were dichotomized into good (2–4 points) and poor (0 or 1 point). Stroke recurrences after the index stroke were recorded. Patients who did not experience stroke recurrence were compared with those who experienced single or multiple stroke recurrences. Results From January 2012 to December 2019, 176 patients were enrolled, of which 116 (65.9%) had no stroke recurrence, 35 (19.9%) had a single stroke recurrence, and 25 (14.2%) had multiple stroke recurrences. Patients with single stroke recurrence (odds ratio [OR]=4.134, 95% confidence interval [CI]=1.822–9.380, p =0.001) and multiple stroke recurrences (OR=6.894, 95% CI=2.489–19.092, p <0.001) were more likely to have poor primary collaterals than those with no stroke recurrence. Conclusions The new PCoA-P1 score appears to provide improve predictions of stroke recurrence in patients with IVBAS.

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Utility of digital subtraction angiography‐based collateral evaluation in medically treated acute symptomatic basilar artery stenosis

Abstract: The DSA-based collateral scoring of the BA large branches might predict long-term outcome in medically treated symptomatic basilar artery stenosis with mild initial severity. Evaluation of BA collateral perfusion status might be useful to determine appropriate treatment strategies.

Cited by 9 publications

References 26 publications

Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017

Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017

Head and neck CT angiography to assess the internal carotid artery stealing pathway

Collateral Flow in Magnetic Resonance Angiography: Prognostic Value for Vertebrobasilar Stenosis With Stroke Recurrence

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