The Prognostic Value of a Four-Dimensional CT Angiography-Based Collateral Grading Scale for Reperfusion Therapy in Acute Ischemic Stroke Patients.
AuthorZhang, S; Chen, W; Tang, H; Han, Q; Yan, S; Zhang, X; Chen, Q; Parsons, M; Wang, S; Lou, M
Source TitlePLoS One
PublisherPublic Library of Science (PLoS)
University of Melbourne Author/sParsons, Mark
Document TypeJournal Article
CitationsZhang, S., Chen, W., Tang, H., Han, Q., Yan, S., Zhang, X., Chen, Q., Parsons, M., Wang, S. & Lou, M. (2016). The Prognostic Value of a Four-Dimensional CT Angiography-Based Collateral Grading Scale for Reperfusion Therapy in Acute Ischemic Stroke Patients.. PLoS One, 11 (8), pp.e0160502-. https://doi.org/10.1371/journal.pone.0160502.
Access StatusOpen Access
Open Access at PMChttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978390
OBJECTIVE: Leptomeningeal collaterals, which affects tissue fate, are still challenging to assess. Four-dimensional CT angiography (4D CTA) originated from CT perfusion (CTP) provides the possibility of non-invasive and time-resolved assessment of leptomeningeal collateral flow. We sought to develop a comprehensive rating system to integrate the speed and extent of collateral flow on 4D CTA, and investigate its prognostic value for reperfusion therapy in acute ischemic stroke (AIS) patients. METHODS: We retrospectively studied 80 patients with M1 ± internal carotid artery (ICA) occlusion who had baseline CTP before intravenous thrombolysis. The velocity and extent of collaterals were evaluated by regional leptomeningeal collateral score on peak phase (rLMC-P) and temporally fused intensity projections (tMIP) (rLMC-M) on 4D CTA, respectively. The cutoffs of rLMC-P and rLMC-M score for predicting good outcome (mRS score ≤ 2) were integrated to develop the collateral grading scale (CGS) (rating from 0-2). RESULTS: The CGS score was correlated with 3-months mRS score (non-recanalizers: ρ = -0.495, p = 0.01; recanalizers: ρ = -0.671, p < 0.001). Patients with intermediate or good collaterals (CGS score of 1 and 2) who recanalized were more likely to have good outcome than those without recanalization (p = 0.038, p = 0.018), while there was no significant difference in outcome in patients with poor collaterals (CGS score of 0) stratified by recanalization (p = 0.227). CONCLUSIONS: Identification of collaterals based on CGS may help to select good responders to reperfusion therapy in patients with large artery occlusion.
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