Multiphase CT angiography is a reliable tool for imaging selection in patients with AIS.

BACKGROUND AND PURPOSE:Carotid webs may cause recurrent ischemic stroke. We describe the prevalence, demographics, clinical presentation, imaging features, histopathology, and stroke risk associated with this under-recognized lesion.

BACKGROUND AND PURPOSE:Collateral status at baseline is an independent determinant of clinical outcome among patients with acute ischemic stroke. We sought to identify whether the association between recanalization after intra-arterial acute stroke therapy and favorable clinical response is modified by the presence of good collateral flow assessed on baseline CTA.

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Background and Purpose In the IMS III trial, we sought to demonstrate evidence of a differential treatment effect of endovascular treatment of acute ischemic stroke compared to intravenous tPA, according to baseline collateral status measured using CT angiography. Methods Of 656 patients enrolled in IMS III, 306 had baseline CTA. Of these, 185 patients had M1 MCA ± intracranial ICA occlusion where baseline collateral status could be measured. Collateral status was assessed by consensus using 3 different ordinal scales and categorized as good, intermediate and poor. Multivariable modeling was used to assess the effect of collateral status and treatment type on clinical outcome (mRS 0–2, mRS 0–1 and the ordinal mRS scale). Results Of 185 patients, 126 randomized to endovascular therapy (87.6% recanalized, 41.3% 90-day mRS 0–2) and 59 to IV tPA only (60.5% recanalized, 30.5% 90-day mRS 0–2). In multivariable modeling, collateral status was a significant predictor of all clinical outcomes (p<0.05). Maximal benefit with endovascular treatment across all clinical outcomes was seen in patients with intermediate collaterals, some benefit in patients with good collaterals and none in patients with poor collaterals) although small sample size limited the power of the analysis to show a statistically significant interaction between collateral status and treatment type (p>0.05). Conclusion Using data from a large RCT (IMS III), we show that baseline CTA collaterals are a robust determinant of final clinical outcome and could be used to select patients for endovascular therapy. Clinical Trials Registration Information https://clinicaltrials.gov/ct2/show/NCT00359424 NCT00359424