Regional Leptomeningeal Score on CT Angiography Predicts Clinical and Imaging Outcomes in Patients with Acute Anterior Circulation Occlusions

Menon, Bijoy K; Smith, Eric E.; Modi, Jayesh; Patel, Shiel K.; Bhatia, Rohit; Watson, Timothy; Hill, Michael D.; Demchuk, Andrew M.; Goyal, Mayank

doi:10.3174/ajnr.a2564

Cited by 285 publications

(254 citation statements)

References 26 publications

Supporting

Mentioning

236

Contrasting

Unclassified

Order By: Relevance

“…2010; Menon et al. 2011). Besides collateral status, recanalization is strongly associated with improved functional outcomes and reduced mortality (Rha and Saver 2007), more specifically, substantial angiographic reperfusion seems to be the best predictor for independence after 3 months (Yoo et al.…”

Section: Introductionmentioning

confidence: 99%

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

View full text Add to dashboard Cite

PurposeClinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.MethodsIn our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT‐CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data‐driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.ResultsSuccessful angiographic reperfusion (OR 26.50; 95%‐CI 9.33–83.61) and good collaterals (OR 9.69; 95%‐CI 2.28–59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%‐CI 0.14–0.85), younger age (OR 0.88; 95%‐CI 0.83–0.92) and higher NCCT ASPECTS (OR 2.54; 95%‐CI 1.01–6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.Conclusions CTA‐collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA‐collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA‐collaterals.

show abstract

Section: Introductionmentioning

confidence: 99%

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

View full text Add to dashboard Cite

show abstract

“…4,6,[8][9][10] The latter offers the advantages of short scan times and wide availability. In conventional CTA, however, the assessment of collaterals is heavily dependent on the timing of image acquisition.…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Beyer¹,

Baumgarten

Thierfelder³

et al. 2014

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

The velocity of collateral filling can be assessed in dynamic time-resolved computed tomography (CT) angiographies and may predict initial CT perfusion (CTP) and follow-up lesion size. We included all patients with an M1 ± internal carotid artery (ICA) occlusion and follow-up imaging from an existing cohort of 1791 consecutive patients who underwent multimodal CT for suspected stroke. The velocity of collateral filling was quantified using the delay of time-to-peak (TTP) enhancement of the M2 segment distal to the occlusion. Cerebral blood volume (CBV) and mean transit time (MTT)-CBV mismatch were assessed in initial CTP. Follow-up lesion size was assessed by magnetic resonance imaging (MRI) or non-enhanced CT (NECT). Multivariate analyses were performed to adjust for extent of collateralization and type of treatment. Our study comprised 116 patients. Multivariate analysis showed a short collateral blood flow delay to be an independent predictor of a small CBV lesion (P o 0.001) and a large relative mismatch (P o 0.001) on initial CTP, of a small follow-up lesion (P o 0.001), and of a small difference between initial CBV and follow-up lesion size (P = 0.024). Other independent predictors of a small lesion on follow-up were a high morphologic collateral grade (P = 0.001), lack of an additional ICA occlusion (P = 0.009), and intravenous thrombolysis (P = 0.022). Fast filling of collaterals predicts initial CTP and follow-up lesion size and is independent of extent of collateralization.

show abstract

“…Copen et al 2009;Leslie-Mazwi et al 2015;González et al 2013) Cheng-Cheng and others have previously demonstrated that patient collateral status, not time, is the primary determinant of infarct volume after stroke. (Cheng-Ching et al 2015;Nicoli et al 2014;Menon et al 2011;Nambiar et al 2014) Our results are in line with these findings and support the hypothesis that the nature of stroke evolution may be less time dependent than previously assumed.…”

Section: Discussionsupporting

confidence: 82%

Beyond 6 Hours: With MR Selection, Improved Outcomes after Successful Late Thrombectomy in Anterior Circulation Large Vessel Occlusion Stroke

Cristiano¹,

Pond²,

Basu³

et al.

The Winnower

View full text Add to dashboard Cite

Regional Leptomeningeal Score on CT Angiography Predicts Clinical and Imaging Outcomes in Patients with Acute Anterior Circulation Occlusions

Cited by 285 publications

References 26 publications

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Beyond 6 Hours: With MR Selection, Improved Outcomes after Successful Late Thrombectomy in Anterior Circulation Large Vessel Occlusion Stroke

Contact Info

Product

Resources

About