Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke

Boers, Anna M. M.; Barros, Renan Sales; Jansen, Ivo G. H.; Berkhemer, Olvert A.; Beenen, Ludo F. M.; Menon, Bijoy K; Dippel, Diederik W.J.; Lugt, Aad van der; Zwam, Wim H van; Roos, Yvo B.W.E.M.; Oostenbrugge, Robert J. van; Slump, C. H.; Majoie, Charles B. L. M.; Marquering, Henk A.

doi:10.3174/ajnr.a5623

Cited by 48 publications

(44 citation statements)

References 32 publications

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“…Thus, LVO patients are an optimal population to investigate the effect of leptomeningeal and upstream collateral circulation systems. The currency of good collaterals manifests as having larger salvageable penumbra and permitting longer delays in achieving reperfusion [2,3]. Factors such as age, chronic hypertension, diabetes, blood glucose levels, and systolic blood pressure at presentation influence the integrity of collat-eral circulation [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

et al. 2020

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Background: Adequate collateral circulation improves the clinical outcome of ischemic stroke patients. We evaluated the influence of ipsilateral carotid stenosis on intracranial collateral circulation in acute stroke patients. Methods: We collected the data of 385 consecutive acute stroke patients who underwent mechanical thrombectomy after multimodal computed tomography (CT) imaging in a single high-volume stroke center. Patients with occlusion of the first segment (M1) segment of the middle cerebral artery were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of carotid stenosis on intracranial collateral circulation was studied with appropriate statistical tests and ordinal regression analysis. Results: Fifty out of the 247 patients eligible for analysis had severe ipsilateral carotid stenosis (≥75%). These patients were 4-times more likely to have very good intracranial collaterals (Collateral Score 3-4, p = 0.001) than the nonstenotic and slightly stenotic (< 75%) patients. The severely stenotic patients had a longer mean operation time (41 vs. 29 min to reperfusion, respectively, p = 0.001). Nevertheless, 54% of severely stenotic patients had good 3-month clinical outcome (modified Rankin Scale ≤2) with no significant difference between the 2 groups. Conclusions: Carotid artery stenosis of over 75% of vessel diameter was associated with better intracranial collateral circulation of patients with acute ischemic stroke. This did not significantly change the 3-month clinical outcome.

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Section: Introductionmentioning

confidence: 99%

Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

et al. 2020

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“…If the ischemic area was compensated by the contralateral cerebral vasculature, the collateral flow as observed on CTA would be greater. (2) Further, the time of CTA acquisition is associated with the concentration of contrast material in the cerebral vessels, which could have influenced the observed collateral flow [14][15][16]. 3As single-phase head CTA captures one snapshot at a set time point, small errors in the scanning time could have also influenced the collateral flow apparent on the images [17].…”

Section: Discussionmentioning

confidence: 99%

Capillary Index Score Derived from Computed Tomography Angiography as An Indicator of Collateral Flow after Acute Ischemic Stroke

Shang¹,

Zhang²,

Li³

2019

Preprint

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Background The capillary index score (CIS) determined from DSA is used to evaluate cerebral collateral flow in acute ischemic stroke (AIS) caused by cerebral artery occlusion. Our aim was to determine the reliability of CIS calculated from MIP-CTA images as an alternative to DSA-based CIS, as CTA is less invasive and less expensive. Methods Clinical and imaging data of 40 patients with AIS caused by cerebral artery occlusion within 6 h from symptom onset were collected. CIS was calculated from CTA and DSA images. Patients were classified into the favorable collateral flow group if CIS was ≥2 (fCIS), and into the poor collateral flow group if CIS was <2 (pCIS). Agreement between the methods was evaluated using the Kappa test. Logistic regression was performed to explore the relationship between CTA-based CIS and clinical outcomes. Results The two methods had high consistency (Kappa = 0.72), and the diagnostic accuracy of CTA for CIS classification was 87.5%. The decrease in the NIHSS score at discharge was not significantly different between the fCIS and pCIS groups according to CTA (p = 0.156), while the 90-day mRS was higher in the pCIS group (p = 0.04). High CTA-based CIS and low blood glucose at admission were significantly correlated with good outcome. Conclusion CIS calculated using CTA is as reliable as DSA-based CIS for assessing collateral flow in AIS, and is also a good predictor of clinical outcome. This index could be useful for guiding patient selection and treatment strategies for AIS.

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“…Validated (semi-) automated quantitative methods to extract information from radiological images like collateral capacity ( 29 ), early ischemic changes ( 30 ), thrombus characteristics ( 10 , 31 ), infarct ( 32 ), and hemorrhage ( 33 ) characteristics are available to determine radiological characteristics of follow up. We are creating a library of vessel geometries based on the intracranial arteries segmented from baseline imaging data.…”

Section: Methodsmentioning

confidence: 99%

In-Silico Trials for Treatment of Acute Ischemic Stroke

et al. 2020

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Despite improved treatment, a large portion of patients with acute ischemic stroke due to a large vessel occlusion have poor functional outcome. Further research exploring novel treatments and better patient selection has therefore been initiated. The feasibility of new treatments and optimized patient selection are commonly tested in extensive and expensive randomized clinical trials. in-silico trials, computer-based simulation of randomized clinical trials, have been proposed to aid clinical trials. In this white paper, we present our vision and approach to set up in-silico trials focusing on treatment and selection of patients with an acute ischemic stroke. The INSIST project (IN-Silico trials for treatment of acute Ischemic STroke, www.insist-h2020.eu) is a collaboration of multiple experts in computational science, cardiovascular biology, biophysics, biomedical engineering, epidemiology, radiology, and neurology. INSIST will generate virtual populations of acute ischemic stroke patients based on anonymized data from the recent stroke trials and registry, and build on the existing and emerging in-silico models for acute ischemic stroke, its treatment (thrombolysis and thrombectomy) and the resulting perfusion changes. These models will be used to design a platform for in-silico trials that will be validated with existing data and be used to provide a proof of concept of the potential efficacy of this emerging technology. The platform will be used for preliminary evaluation of the potential suitability and safety of medication, new thrombectomy device configurations and methods to select patient subpopulations for better treatment outcome. This could allow generating, exploring and refining relavant hypotheses on potential causal pathways (which may follow from the evidence obtained from clinical trials) and improving clinical trial design. Importantly, the findings of the in-silico trials will require validation under the controlled settings of randomized clinical trials.

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Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke

Abstract: Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.

Cited by 48 publications

References 32 publications

Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

Capillary Index Score Derived from Computed Tomography Angiography as An Indicator of Collateral Flow after Acute Ischemic Stroke

In-Silico Trials for Treatment of Acute Ischemic Stroke

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