Inter- and intraobserver reliability for angiographic leptomeningeal collateral flow assessment by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale

Hassen, Wagih Ben; Malley, C. O; Boulouis, Grégoire; Clarençon, Frédéric; Bartolini, Bruno; Bourcier, Romain; Régent, Christine Rodriguez; Bricout, Nicolas; Labeyrie, Marc Antoine; Gentric, Jean-Christophe; Rouchaud, Aymeric; Soize, Sébastien; Saleme, Suzana; Raoult, Hélène; Gallas, Sophie; Eugène, François; Anxionnat, René; Herbreteau, Denis; Bracard, Serge; Naggara, Olivier

doi:10.1136/neurintsurg-2018-014185

Cited by 47 publications

(30 citation statements)

References 37 publications

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“…There were no significant differences in age, sex, presentation systolic blood pressure, medical comorbidities or other factors between patients with good and poor collaterals ( Table 1). Stroke severity did not significantly differ between patients with good (median NIHSS score 14; IQR, [11][12][13][14][15][16][17][18] and poor (median NIHSS score 17; IQR, 13-21; P = 0.077) collaterals. The side of the stroke and frequency of intravenous thrombolysis therapy did not differ between groups (Table 1).…”

Section: Resultsmentioning

confidence: 82%

“…Given the increasing use of perfusion imaging in the triage of patients with AIS, HIR determined by CT or MR perfusion may serve as a valuable biomarker of collateral status. The ability to calculate HIR using automated software (RAPID) eliminates potential inter-reader variability that often limits alternative assessments of collateral status [15], makes HIR a powerful tool in the evaluation of patients with AIS being considered for interfacility transfer for EMT [19] and gives perfusion a strong advantage in collateral evaluation compared with CTA.…”

Section: Discussionmentioning

confidence: 99%

“…Collateral assessment by computed tomography (CT) angiography (CTA) or multiphase CTA [11,12] is well described [13]. However, the correlation between CTA and DSA measures of collaterals is inconsistent [14] and subject to inter-reader variability [15,16]. Lastly, CTA-based measures of arterial collaterals cannot be applied to patients undergoing magnetic resonance (MR) angiography (MRA) using time-of-flight techniques and tissue-level blood-flow information is not provided by non-invasive angiographic techniques.…”

Section: Introductionmentioning

confidence: 99%

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Hypoperfusion intensity ratio correlates with angiographic collaterals in acute ischaemic stroke with M1 occlusion

Guenego

Fahed

Albers

et al. 2020

Euro J of Neurology

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Background and purpose: Among patients with an acute ischaemic stroke secondary to large-vessel occlusion, the hypoperfusion intensity ratio (HIR) [time to maximum (TMax) > 10 volume/TMax > 6 volume] is a strong predictor of infarct growth. We studied the correlation between HIR and collaterals assessed with digital subtraction angiography (DSA) before thrombectomy. Methods: Between January 2014 and March 2018, consecutive patients with an acute ischaemic stroke and an M1 middle cerebral artery (MCA) occlusion who underwent perfusion imaging and endovascular treatment at our center were screened. Ischaemic core (mL), HIR and perfusion mismatch (TMax > 6 s minus core volume) were assessed through magnetic resonance imaging or computed tomography perfusion. Collaterals were assessed on pre-intervention DSA using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Baseline clinical and perfusion characteristics were compared between patients with good (ASITN/SIR score 3-4) and those with poor (ASITN/SIR score 0-2) DSA collaterals. Correlation between HIR and ASITN/SIR scores was evaluated using Pearson's correlation. Receiver operating characteristic analysis was performed to determine the optimal HIR threshold for the prediction of good DSA collaterals. Results: A total of 98 patients were included; 49% (48/98) had good DSA collaterals and these patients had significantly smaller hypoperfusion volumes (TMax > 6 s, 89 vs. 125 mL; P = 0.007) and perfusion mismatch volumes (72 vs. 89 mL; P = 0.016). HIR was significantly correlated with DSA collaterals (À0.327; 95% confidence interval, À0.494 to À0.138; P = 0.01). An HIR cutoff of <0.4 best predicted good DSA collaterals with an odds ratio of 4.3 (95% confidence interval, 1.8-10.1) (sensitivity, 0.792; specificity, 0.560; area under curve, 0.708). Conclusion: The HIR is a robust indicator of angiographic collaterals and might be used as a surrogate of collateral assessment in patients undergoing magnetic resonance imaging. HIR <0.4 best predicted good DSA collaterals.

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Section: Resultsmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypoperfusion intensity ratio correlates with angiographic collaterals in acute ischaemic stroke with M1 occlusion

Guenego

Fahed

Albers

et al. 2020

Euro J of Neurology

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“…The choice of keeping only easily accessible criteria explains the non-accounting of leptomeningeal collaterality assessment in the MT-DRAGON score. As recently described, the standard classification (American Society of Interventional and Therapeutic Neuroradiology) based on DSA is not reliable,23 and cannot be obtained at the early stage of management, before groin puncture. Current non-invasive methods of assessing collaterality have not yet been recommended by recent guidelines for early management of patients with AIS-LVO 1…”

Section: Discussionmentioning

confidence: 99%

MT-DRAGON score for outcome prediction in acute ischemic stroke treated by mechanical thrombectomy within 8 hours

Hassen¹,

Bricout²,

Boulouis³

et al. 2019

J NeuroIntervent Surg

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ObjectivesThe MRI-DRAGON score includes clinical and MRI parameters and demonstrates a high specificity in predicting 3 month outcome in patients with acute ischemic stroke (AIS) treated with intravenous tissue plasminogen activator (IV tPA). The aim of this study was to adapt this score to mechanical thrombectomy (MT) in a large multicenter cohort.MethodsConsecutive cases of AIS treated by MT between January 2015 and December 2017 from three stroke centers were reviewed (n=1077). We derived the MT-DRAGON score by keeping all variables of the MRI-DRAGON score (age, initial National Institutes of Health Stroke Scale score, glucose level, pre-stroke modified Rankin Scale (mRS) score, diffusion weighted imaging-Alberta Stroke Program Early CT score ≤5) and considering the following variables: time to groin puncture instead of onset to IV tPA time and occlusion site. Unfavorable 3 month outcome was defined as a mRS score >2. Score performance was evaluated by c statistics and an external validation was performed.ResultsAmong 679 included patients (derivation and validation cohorts, n=431 and 248, respectively), an unfavorable outcome was similar between the derivation (51.5%) and validation (58.1%, P=0.7) cohorts, and was significantly associated with all MT-DRAGON parameters in the multivariable analysis. The c statistics for unfavorable outcome prediction was 0.83 (95%CI 0.79 to 0.88) in the derivation and 0.8 (95%CI 0.75 to 0.86) in the validation cohort. All patients (n=55) with an MT-DRAGONscore ≥11 had an unfavorable outcome and 60/63 (95%) patients with an MT-DRAGON score ≤2 points had a favorable outcome.ConclusionThe MT-DRAGON score is a simple tool, combining admission clinical and radiological parameters that can reliably predict 3 month outcome after MT.

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“…Using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral scale, based on DSA, it classifies the cerebral collateral status to grades from 0 to 4. When there is a dichotomized score, "inadequate collaterals" (score of 0, 1, or 2) versus "adequate collaterals" (score of 3 or 4) was used [12].…”

Section: Angiography and Assessment Of Collateral Circulationmentioning

confidence: 99%

Cerebrovascular reactivity recovery following carotid angioplasty and stenting

Hashem

Belal

Hegazy

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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Background: Internal carotid artery high-grade stenosis is a major cause of stroke. Carotid angioplasty and stenting (CAS) is a reasonable approach for treatment of certain patients. Cerebrovascular reactivity (CVR) evaluated through breath holding index test can assess the outcome following CAS. Aim: Evaluate changes in CVR before and after CAS. Subjects and method: Thirty-two patients with 35 symptomatic internal carotid artery high-grade stenosis (> 70%) were enrolled by the mean of ultrasound screening. Breath holding index test was done using transcranial Doppler ultrasound before and after CAS. Results: The study includes 32 patients (22 males and 10 females). The mean age was 61.91 ± 6.59 years. The main risk factor was hypertension (75.3%). All patients showed an increase in mean flow velocity and BHI following CAS (P < 0.001) on both ipsilateral and contralateral side. Both groups (70-90% and > 90% stenosis) showed similar improvement of CVR. Conclusion: CAS improves CVR in all high grades of internal carotid artery stenosis.

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Inter- and intraobserver reliability for angiographic leptomeningeal collateral flow assessment by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale

Cited by 47 publications

References 37 publications

Hypoperfusion intensity ratio correlates with angiographic collaterals in acute ischaemic stroke with M1 occlusion

Hypoperfusion intensity ratio correlates with angiographic collaterals in acute ischaemic stroke with M1 occlusion

MT-DRAGON score for outcome prediction in acute ischemic stroke treated by mechanical thrombectomy within 8 hours

Cerebrovascular reactivity recovery following carotid angioplasty and stenting

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