Assessment of Intracranial Collaterals on CT Angiography in Anterior Circulation Acute Ischemic Stroke

Yeo, Leonard L.L.; Paliwal, Prakash; Teoh, Hl L.; Seet, Raymond C.S.; Chan, BP; Ting, Eric; Venketasubramanian, Narayanaswamy; Leow, Wk K.; Wakerley, Benjamin R; Kusama, Yoshiki; Rathakrishnan, Rahul; Sharma, Vijay K.

doi:10.3174/ajnr.a4117

Cited by 103 publications

(104 citation statements)

References 30 publications

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“…Good collaterals and smaller early infarct changes, respectively, are associated with better outcomes. [1][2][3][4][5] Despite widespread acceptance of their importance, seemingly basic relationships and objective methods of quantification of the collaterals and infarct size for optimal clinical use remain ambiguous.…”

mentioning

confidence: 99%

Good Intracranial Collaterals Trump Poor ASPECTS (Alberta Stroke Program Early CT Score) for Intravenous Thrombolysis in Anterior Circulation Acute Ischemic Stroke

Tan

Kong

Paliwal

et al. 2016

Stroke

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Two independent neuroradiologists determined their ASPECTS. We stratified patients using ASPECTS into 2 groups: large volume infarcts (ASPECTS≤7 points) and small volume infarcts . In addition, we evaluated a third group with very large volume infarcts (ASPECTS≤5 points). We then analyzed the 3 subgroups using the Maas, Tan, and ASPECTS-collaterals grading systems of the computed tomographic angiogram intracranial collaterals. Good outcomes were defined by modified Rankin Scale score of 0 to 2 at 3 months. Results-A total of 300 patients were included in the final analysis. For patients with very large volume infarcts (ASPECTS≤5 points), univariable analysis showed that younger age, male sex, lower National Institute of Health Stroke Scale (NIHSS), lower systolic blood pressure, and good collaterals by Maas, Tan, or ASPECTS-collaterals grading were predictors of good outcomes. On multivariate analysis, younger age (odds ratio, 0.93; 95% confidence interval, 0.89-0.97; P=0.002) and good collaterals by ASPECTS-collaterals system (odds ratio, 1.34; 95% confidence interval, 1.15-1.57; P<0.001) were associated with good outcomes. Conclusions-In patients with large and very large volume infarcts, good collaterals as measured by the ASPECTScollaterals system is associated with improved outcomes and can help select patients for intravenous thrombolysis.

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confidence: 99%

Good Intracranial Collaterals Trump Poor ASPECTS (Alberta Stroke Program Early CT Score) for Intravenous Thrombolysis in Anterior Circulation Acute Ischemic Stroke

Tan

Kong

Paliwal

et al. 2016

Stroke

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“…14 The leptomeningeal collateral status on the prethrombolysis CTA was assessed by 3 predefined criteria-Maas, Tan, and ASPECTS collaterals, which have been previously described. [15][16][17][18][19] Functional outcome was assessed by the modified Rankin Scale (mRS) at 3 months. An mRS score of 0-1 represented a favorable functional outcome.…”

Section: Methodsmentioning

confidence: 99%

Intravenous Thrombolysis for Acute Ischemic Stroke due to Cervical Internal Carotid Artery Occlusion

Yeo

Kong

Paliwal

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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“…The currently proposed methods of assessing collaterals are largely qualitative or semiquantitative, and there are no clear indications of the superiority of any of the available techniques 57 . This lack of consensus may contribute to an overall under appreciation of the fundamental role of collateral circulation in outcomes following AIS.…”

Section: Imaging Studies Of Collateral Circulation In the Clinical Sementioning

confidence: 99%

Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

Alves¹,

Pacheco²,

Rocha³

2016

Arq. Neuro-Psiquiatr.

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Collateral circulation is a physiologic pathway that protects the brain against ischemic injury and can potentially bypass the effect of a blocked artery, thereby influencing ischemic lesion size and growth. Several recent stroke trials have provided information about the role of collaterals in stroke pathophysiology, and collateral perfusion has been recognized to influence arterial recanalization, reperfusion, hemorrhagic transformation, and neurological outcomes after stroke. Our current aim is to summarize the anatomy and physiology of the collateral circulation and to present and discuss a comprehensible review of the related knowledge, particularly the effects of collateral circulation on the time course of ischemic injury and stroke severity, as well as imaging findings and therapeutic implications.

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Assessment of Intracranial Collaterals on CT Angiography in Anterior Circulation Acute Ischemic Stroke

Cited by 103 publications

References 30 publications

Good Intracranial Collaterals Trump Poor ASPECTS (Alberta Stroke Program Early CT Score) for Intravenous Thrombolysis in Anterior Circulation Acute Ischemic Stroke

Good Intracranial Collaterals Trump Poor ASPECTS (Alberta Stroke Program Early CT Score) for Intravenous Thrombolysis in Anterior Circulation Acute Ischemic Stroke

Intravenous Thrombolysis for Acute Ischemic Stroke due to Cervical Internal Carotid Artery Occlusion

Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

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