Internal Carotid Artery Stenosis and Collateral Recruitment in Stroke Patients

Dankbaar, Jan Willem; Kerckhoffs, Kelly G P; Horsch, Alexander D.; Schaaf, Irene C. van der; Kappelle, L. Jaap; Velthuis, Birgitta K.; investigators, Dust

doi:10.1007/s00062-017-0568-x

Cited by 19 publications

(8 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Currently, both methods are rater-dependent since they rely on visual rating scales. 57,58 Conventional collateral scores obtained from CTA and DSA did not show significant correlations with CVI PWI or clinical outcome measures at admission. This might be due to the fact that the scan duration of conventional CTA in some cases can be too short to detect collateral filling in the late venous phase and that the DSA-based collateral score used in this study is determined by unilateral angiographic examination of the affected side only and, therefore, might fail to capture the crossflow to leptomeningeal vessels from the contralateral unaffected side.…”

Section: Discussionmentioning

confidence: 90%

“…Furthermore, also CTP can be used to directly assess leptomeningeal collateralization in acute stroke, using a time-resolved approach. 57,58 However, acquisition captures fewer images of the brain during bolus passage 57,58 than in MR DSC perfusion, leading to limitations regarding late collateral filling. Furthermore, there are issues around radiation dose when repeatedly imaging the brain during bolus arrival.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Signal variance-based collateral index in DSC perfusion: A novel method to assess leptomeningeal collateralization in acute ischaemic stroke

Seiler

Lauer

Deichmann

et al. 2019

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

As a determinant of the progression rate of the ischaemic process in acute large-vessel stroke, the degree of collateralization is a strong predictor of the clinical outcome after reperfusion therapy and may influence clinical decision-making. Therefore, the assessment of leptomeningeal collateralization is of major importance. The purpose of this study was to develop and evaluate a quantitative and observer-independent method for assessing leptomeningeal collateralization in acute large-vessel stroke based on signal variance characteristics in T2*-weighted dynamic susceptibility contrast (DSC) perfusion-weighted MR imaging (PWI). Voxels representing leptomeningeal collateral vessels were extracted according to the magnitude of signal variance in the PWI raw data time series in 55 patients with proximal large-artery occlusion and an intra-individual collateral vessel index (CVIPWI) was calculated. CVIPWI correlated significantly with the initial ischaemic core volume (rho = −0.459, p = 0.0001) and the PWI/DWI mismatch ratio (rho = 0.494, p = 0.0001) as an indicator of the amount of salvageable tissue. Furthermore, CVIPWI was significantly negatively correlated with NIHSS and mRS at discharge (rho = −0.341, p = 0.015 and rho = −0.305, p = 0.023). In multivariate logistic regression, CVIPWI was an independent predictor of favourable functional outcome (mRS 0–2) (OR = 16.39, 95% CI 1.42–188.7, p = 0.025). CVIPWI provides useful rater-independent information on the leptomeningeal collateral supply in acute stroke.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Signal variance-based collateral index in DSC perfusion: A novel method to assess leptomeningeal collateralization in acute ischaemic stroke

Seiler

Lauer

Deichmann

et al. 2019

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

show abstract

“…However, in our study, when distinguishing distal and proximal segment of ICA occlusions, we found more patients with proximal segment of ICA occlusion and fewer patients with distal ICA occlusions achieved functional independence. The reason for this difference may be most of proximal segment of ICA occlusion were related to chronic stenosis possibly with a rich collateral network [ 36 ]. Consistent with previous studies, high ASPECTS score was demonstrated to be associated with functional independence of AIS patients after EVT in this study [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

NIHSS Consciousness Score Combined with ASPECTS is a Favorable Predictor of Functional Outcome post Endovascular Recanalization in Stroke Patients

Cheng¹,

Xu²,

Rajah³

et al. 2021

Aging and disease

View full text Add to dashboard Cite

Although revascularization rates after endovascular thrombectomy for large vessel acute ischemic stroke (AIS) are high (71%), only 46% of patients achieve functional independence at 90 days. The present study was designed to explore a new method for predicting the functional prognosis of AIS patients after endovascular recanalization. A total of 200 anterior circulation stroke patients who received endovascular therapy were enrolled. Logistic regression analysis of clinical characteristics on functional independence were performed. The predictive power of sub-items in National Institute of Health stroke scale (NIHSS) and the combination of NIHSS consciousness and Alberta Stroke Program Early CT Score (ASPECTS) on functional independence were assessed by Receiver Operating Characteristic (ROC) curves and the latter was compared with 3 previously published prediction models by AUC (the area under ROC curve). The AUC for the NIHSS consciousness score to predict functional independence was higher than whole NIHSS and other sub-items (0.716 v 0.705, 0.586, 0.573, 0.552 and 0.559). Low NIHSS consciousness score, high ASPECTS score, short time from onset to recanalization, and high rate of successful recanalization were demonstrated to be significantly associated with the functional independence (OR 0.697, 2.226, 0.994 and 28.643). The prediction power of the combination was significantly better than NIHSS and ASPECTS alone (AUC 0.793 v 0.705 and 0.752). Compared with 3 other prediction models, the combination was found to be the strongest predictor for functional independence (AUC 0.793 v 0.791, 0.671 and 0.564). NIHSS which has been shown to be a strong predictor of functional outcomes after endovascular recanalization is largely dependent on the consciousness component. NIHSS consciousness score combined with ASPECTS appears to be a favorable predictor of functional independence. These findings may have broad reaching effects for isolated centers around the world without advanced imaging for triage and prognostication.

show abstract

“…As previous studies revealed, CTP scans were performed with the 64-slice detector CT scanner (Philips, Best, the Netherlands) and followed with injection of diluted nonionic contrast material. CTP data were then transferred to a postprocessing workstation (Extended Brilliance Workstation v 3.0, Philips Medical Systems) [ 22 ]. Cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time to peak (TTP) were calculated using a deconvolution operation (Extend Brilliance Workstation v 3.0, Philips Medical Systems, USA).…”

Section: Methodsmentioning

confidence: 99%

Different Grades of Collateral Circulation for Evaluating Cerebral Hemodynamic Status in Carotid Artery Stenosis

Fan

Shi

Rong

et al. 2022

Journal of Healthcare Engineering

View full text Add to dashboard Cite

Normally, ipsilateral hemodynamic compromise of patients with carotid stenosis (CS) is subjectively identified by collateral circulation through cerebral angiography in the clinical process. It is unclear whether collaterals would linearly determine cerebral perfusion in CS patients. This study aimed to investigate the independent role of collateral circulation on cerebral perfusion in CS patients and the underlying interrelations among them. From 2017 to 2020, 124 CS patients who underwent carotid endarterectomy (CEA) with both preoperative CTP and digital substruction angiography (DSA) images were enrolled. Division of subgroups was based on degree of CS (50–70%, 70–90%, and near-occlusion (NO)) and grades of collateral circulation by DSA. Differences in CTP parameters between CS patients with different collateral circulation were analyzed. Among 124 CS patients, grades 2 and 3 were highly associated with carotid NO (n = 22, 32.35% and n = 22, 32.35%) compared with others ( P < 0.0001 ). The collateral circulation was found to have poor relation with cerebral perfusion parameters in all enrolled patients but significantly improved ipsilateral cerebral perfusion in patients with carotid NO ( P < 0.05 ). Linear hemodynamic compromise was barely related to degree of CS in lobes supplied by middle cerebral artery (MCA) except the frontal lobe ( P < 0.05 ). The grades of collateral circulation are positively associated with degree of CS while having nonsignificant effect on cerebral perfusion. Overall, severity of CS is poorly related to hemodynamic status while the perfectibility of compensation defined by grades of collateral circulation effectively alleviates ipsilateral cerebral perfusion deficit in carotid NO.

show abstract

Internal Carotid Artery Stenosis and Collateral Recruitment in Stroke Patients

Cited by 19 publications

References 26 publications

Signal variance-based collateral index in DSC perfusion: A novel method to assess leptomeningeal collateralization in acute ischaemic stroke

Signal variance-based collateral index in DSC perfusion: A novel method to assess leptomeningeal collateralization in acute ischaemic stroke

NIHSS Consciousness Score Combined with ASPECTS is a Favorable Predictor of Functional Outcome post Endovascular Recanalization in Stroke Patients

Different Grades of Collateral Circulation for Evaluating Cerebral Hemodynamic Status in Carotid Artery Stenosis

Contact Info

Product

Resources

About