Performance of CT ASPECTS and Collateral Score in Risk Stratification: Can Target Perfusion Profiles Be Predicted without Perfusion Imaging?

Dehkharghani, Seena; Bammer, Roland; Straka, Matús; Bowen, Meredith; Allen, Jason W.; Rangaraju, Srikant; Kang, Jian; Gleason, Thomas G.; Brasher, Christopher; Nahab, Fadi

doi:10.3174/ajnr.a4727

Cited by 27 publications

(15 citation statements)

References 27 publications

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“…A recent study agreed with our conclusion. In this study, a cerebral blood flow core volume of 50 ml was evaluated, in which NECT-ASPECTS ≥9 with a CTA collateral score of 3 had 100% specificity for identifying patients with a cerebral blood flow core volume ≤50 ml 14 . Our data further showed that the combined interpretation of ASPECTS and collateral scores in agreement is superior to using higher cutoff values of ASPECTS or collateral scores in terms of both predictive capability and IRR.…”

Section: Discussionmentioning

confidence: 99%

Optimal Multiphase Computed Tomographic Angiography-based Infarct Core Estimations for Acute Ischemic Stroke

Lee

Jung

Choi

et al. 2019

Sci Rep

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We evaluated the best methods for predicting various infarct core thresholds for endovascular treatment of ischemic stroke using parameters obtained by multiphase computed tomographic angiography (mCTA). Consecutive patients evaluated for endovascular treatment who concomitantly underwent mCTA and stroke magnetic resonance imaging (MRI) were analyzed. The ability of CTA-based collaterals (single-phase [sCTAc] and multiphase [mCTAc]) and ASPECTS or their combined interpretation for the selection of patients with cores of <31 ml and <70 ml, and ≥100 ml, were compared. In the total 142 patients, the combined interpretation of collateral scores and ASPECTS score indicated significant added benefit for the prediction of smaller infarct volume thresholds (<31 ml) compared to ASPECTS alone. Selection of cases that satisfied both sCTAc 3–5 and ASPECTS 6–10 had the optimal predictive capability and inter-rater reliability. While the combined interpretation did not provide a significant added benefit for the prediction of larger infarct volume thresholds, sCTAc 0–2 and mCTAc 0–2 performed as well as ASPECTS 0–5 in prediction of core volumes ≥100 ml with better inter-rater reliability. sCTA and mCTA can improve the selection of patients for EVT by more accurately predicting lower infarct core volume cutoffs. When excluding patients with large infarct cores, they can improve inter-rater reliability.

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Section: Discussionmentioning

confidence: 99%

Optimal Multiphase Computed Tomographic Angiography-based Infarct Core Estimations for Acute Ischemic Stroke

Lee

Jung

Choi

et al. 2019

Sci Rep

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“…Automated arterial input functions were automatically assigned by RAPID and could include either anterior or posterior circulation vessels. 26 MR Perfusion Imaging. MR perfusion images were obtained following an intravenous injection of gadolinium into an antecubital vein.…”

Section: Imaging Analysis Ct Perfusionmentioning

confidence: 99%

Perfusion Imaging Predicts Favorable Outcomes after Basilar Artery Thrombectomy

Cereda

Bianco

Mlynash

et al. 2021

Annals of Neurology

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Objective: Perfusion imaging identifies anterior circulation stroke patients who respond favorably to endovascular thrombectomy (ET), but its role in basilar artery occlusion (BAO) is unknown. We hypothesized that BAO patients with limited regions of severe hypoperfusion (time to reach maximum concentration in seconds [Tmax] > 10) would have a favorable response to ET compared to patients with more extensive regions involved. Methods: We performed a multicenter retrospective cohort study of BAO patients with perfusion imaging prior to ET. We prespecified a Critical Area Perfusion Score (CAPS; 0-6 points), which quantified severe hypoperfusion (Tmax > 10) in cerebellum (1 point/hemisphere), pons (2 points), and midbrain and/or thalamus (2 points). Patients were dichotomized into favorable (CAPS ≤ 3) and unfavorable (CAPS > 3) groups. The primary outcome was a favorable functional outcome 90 days after ET (modified Rankin Scale = 0-3). Results: One hundred three patients were included. CAPS ≤ 3 patients (87%) had a lower median National Institutes of Health Stroke Scale score (NIHSS; 12.5, interquartile range [IQR] = 7-22) compared to CAPS > 3 patients (13%; 23, IQR = 19-36; p = 0.01). Reperfusion was achieved in 84% of all patients, with no difference between CAPS groups (p = 0.42). Sixty-four percent of reperfused CAPS ≤ 3 patients had a favorable outcome compared to 8% of nonreperfused CAPS ≤ 3 patients (odds ratio [OR] = 21.0, 95% confidence interval [CI] = 2.6-170; p < 0.001). No CAPS > 3 patients had a favorable outcome, regardless of reperfusion. In a multivariate regression analysis, CAPS ≤ 3 was a robust independent predictor of favorable outcome after adjustment for reperfusion, age, and pre-ET NIHSS (OR = 39.25, 95% CI = 1.34->999, p = 0.04). Interpretation: BAO patients with limited regions of severe hypoperfusion had a favorable response to reperfusion following ET. However, patients with more extensive regions of hypoperfusion in critical brain regions did not benefit from endovascular reperfusion.

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“…Though an NCCT ASPECTS score and CTA based collateral score may improve the CTP based candidate selection for revascularization (Dehkharghani et al, 2016) Single-phase computed tomography angiography (CTA) High accuracy in assessing the patency of the arterial segments in the circle of Willis and its anatomical variations.…”

Section: Non-contrast Computerized Tomography (Ncct)mentioning

confidence: 99%

Cerebral collaterals in acute ischaemia: Implications for acute ischaemic stroke patients receiving reperfusion therapy

Ravindran

Killingsworth

Bhaskar

2020

Eur J of Neuroscience

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The cerebral collaterals play an important role in penumbral tissue sustenance after an acute ischaemic stroke. Recent studies have demonstrated the potential role of collaterals in the selection of acute ischaemic stroke patients eligible for reperfusion therapy. However, the understanding of the significance and evidence around the role of collateral status in predicting outcomes in acute ischaemic stroke patients treated with reperfusion therapy is still unclear. Moreover, the use of pre-treatment collaterals in patient selection and prognosis is relatively underappreciated in clinical settings. A focused review of the literature was performed on the various methods of collateral evaluation and the role of collateral status in acute ischaemic stroke patients receiving reperfusion therapy. We discuss the methods of evaluating pre-treatment collaterals in clinical settings. The patient selection based on collateral status as well as the prognostic and therapeutic value of collaterals in acute ischaemic stroke, in settings of intravenous thrombolysis or endovascular therapy alone, and bridge therapy, are summarized. Recommendations for future research and possible pharmacological intervention strategies aimed at collateral enhancement are also discussed. Collaterals may play an important role in identifying acute ischaemic stroke patients who are likely to benefit from endovascular treatment in an extended time window. Future neuroscientific efforts to better improve our understanding of the role of collaterals in | 1239 VISHNI RAVINDRAN et Al.

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Performance of CT ASPECTS and Collateral Score in Risk Stratification: Can Target Perfusion Profiles Be Predicted without Perfusion Imaging?

Cited by 27 publications

References 27 publications

Optimal Multiphase Computed Tomographic Angiography-based Infarct Core Estimations for Acute Ischemic Stroke

Optimal Multiphase Computed Tomographic Angiography-based Infarct Core Estimations for Acute Ischemic Stroke

Perfusion Imaging Predicts Favorable Outcomes after Basilar Artery Thrombectomy

Cerebral collaterals in acute ischaemia: Implications for acute ischaemic stroke patients receiving reperfusion therapy

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