Systematic evaluation of computed tomography angiography collateral scores for estimation of long-term outcome after mechanical thrombectomy in acute ischaemic stroke

Abstract

Purpose This study compares computed tomography angiography-based collateral scoring systems in regard to their inter-rater reliability and potential to predict functional outcome after endovascular thrombectomy, and relates them to parenchymal perfusion as measured by computed tomography perfusion. Methods Eighty-four patients undergoing endovascular thrombectomy in anterior circulation ischaemic stroke were enrolled. Modified Tan Score, Miteff Score, Maas Score and Opercular Index Score ratio were assessed in pre-interventional computed tomography angiographies independently by two readers. Collateral scores were tested for inter-rater reliability by weighted-kappa, for correlations with three-months modified Rankin Scale, and their potential to differentiate between patients with favourable (modified Rankin Scale ≤2) and poor outcome (modified Rankin Scale ≥3). Correlations with relative cerebral blood volume and relative cerebral blood flow were tested in patients with available computed tomography perfusion. Results Very good inter-rater reliability was found for Modified Tan, Miteff and Opercular Index Score ratio, and substantial reliability for Maas. There were no significant correlations between collateral scores and three-months modified Rankin Scale, but significant group differences between patients with favourable and poor outcome for Maas, Miteff and Opercular Index Score ratio. Miteff and Maas were significant predictors of favourable outcome in binary logistic regression analysis. Miteff best differentiated between both outcome groups in receiver-operating characteristics, and Maas reached highest sensitivity for favourable outcome prediction of 96%. All collateral scores significantly correlated with mean relative cerebral blood volume and relative cerebral blood flow. Conclusions Computed tomography angiography scores are valuable in estimating functional outcome after mechanical thrombectomy and reliable across readers. The more complex scores, Maas and Miteff, show the best performances in predicting favourable outcome.

Evolution of Hypodensity on Non-Contrast CT in Correlation with Collaterals in Anterior Circulation Stroke with Successful Endovascular Reperfusion

“…Although our study was limited to assessment of a single imaging factor as an outcome measure, the findings could be regarded as consistent with results of studies showing that collaterals determine functional outcome by the extensively used mRS at 90 days [22][23][24][25][26][27][28][29][30][31][32].…”

Mechanical thrombectomy in stroke patients with acute occlusion of the M1- compared to the M2-segment: Safety, efficacy, and clinical outcome

“…Collateralization is well known as a relevant parameter for clinical outcome in AIS. 11,17 It even showed a greater impact on the clinical outcome than the onset-to-recanalization time in patients with M1-occlusion. Although the factor time has been proven important for clinical outcome in AIS, collateralization may be decisive as well.…”

“…Although the factor time has been proven important for clinical outcome in AIS, collateralization may be decisive as well. 11…”

Visualization of the Anterior Temporal Artery as a Predictor of Outcome in Middle Cerebral Artery Occlusion Patients Achieving Successful Recanalization After Transfer

“…ASPECTS scoring from the NCCT head [ 13 ] can be utilized but its high interobserver variability undermines the practicality of its use [ 14 , 15 ]. Additionally, while CTA-based collateral scoring can be utilized [ 9 , 10 ], the scores that perform best are complex [ 16 ] and are likely considerably more challenging to derive than a binary interpretation of the absence or presence of ATA visualization. Our data strongly suggest that assessing for visualization of the ATA in patients with acute MCA M1 occlusions is predictive of the outcome if successful revascularization can be achieved after transfer for thrombectomy.…”