Tara Srinivas, Dhairya A. Lakhani, Aneri B. Balar, Risheng Xu, Jee Moon, Caline Azzi, Nathan Hyson, Mona Shahriari, Sijin Wen, Cynthia Greene, Janet Mei, Farzad Maroufi, Jeremy J. Heit, Tobias D. Faizy, Gregory W. Albers, Hamza Salim, Meisam Hoseinyazdi, Vivek S. Yedavalli
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We assess the utility of multiphase computed tomography angiography (CTA) derived from CT perfusion (CTP) source imaging (dCTA) in determining collateral status compared to the reference standard American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score on digital subtraction angiography (DSA).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We retrospectively analyzed AIS patients treated at our institution from January 9, 2017, to January 10, 2023. Inclusion criteria included CTA-confirmed anterior circulation large vessel occlusion, diagnostic CTP, and mechanical thrombectomy with documented DSA collateral score. The modified treatment in cerebral ischemia score was used to assess reperfusion. Logistic regression analyses evaluated associations between demographic and clinical factors, collateral status, ASITN/SIR, and reperfusion status.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 311 patients (mean age 67.35 ± 16.37, 57.4% female) were included. Univariate analysis showed that proximal M2 (PM2) occlusion site (odds ratio [OR] 4.45, <i>p</i> < 0.001), Alberta Stroke Program Early CT Score (OR 1.24, <i>p</i> = 0.006), dCTA (OR 3.81, <i>p</i> < 0.001), and CTA Tan (OR 6.05, <i>p</i> < 0.001) were associated with an ASITN score of ≥3, indicating collateral flow. Multivariate regression, adjusted for race, occlusion site, radiologic features, National Institutes of Health stroke score, and premorbid modified Rankin score, found PM2 occlusion site (aOR 5.99, <i>p</i> < 0.001), dCTA (adjusted OR [aOR] 2.24, <i>p</i> = 0.04), and CTA Tan (aOR 3.71, <i>p</i> < 0.01) to be significant predictors of ASITN ≥3.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>dCTA is associated with favorable DSA collateral scores and may aid clinical decision-making in AIS patients with large vessel occlusions. 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引用次数: 0
摘要
背景与目的侧支状态是大血管前循环急性缺血性卒中（AIS）患者再灌注和死亡率的重要预测指标。我们评估了由CT灌注（CTP）源成像（dCTA）衍生的多期计算机断层血管造影（CTA）在确定侧支状态方面的效用，并与参考标准美国介入与治疗神经放射学会/介入放射学会（ASITN/SIR）数字减影血管造影（DSA）侧支评分进行了比较。方法回顾性分析2017年1月9日至2023年1月10日在我院治疗的AIS患者。纳入标准包括cta确认的前循环大血管闭塞，诊断性CTP和机械取栓并记录DSA侧支评分。采用改良后的脑缺血评分法评价再灌注。Logistic回归分析评估了人口统计学和临床因素、侧支状态、ASITN/SIR和再灌注状态之间的关系。结果共纳入311例患者，平均年龄67.35±16.37岁，女性占57.4%。单因素分析显示近端M2 （PM2）闭塞部位(优势比[OR] 4.45, p <；0.001)，阿尔伯塔卒中计划早期CT评分（OR 1.24, p = 0.006）， dCTA (OR 3.81, p <；0.001)和CTA Tan (OR 6.05, p <；0.001)与ASITN评分≥3分相关，表明侧支血流。多因素回归，调整种族、闭塞部位、放射学特征、美国国立卫生研究院卒中评分和病前改良Rankin评分，发现PM2闭塞部位(aOR 5.99, p <；0.001)、dCTA（调整后OR [aOR] 2.24, p = 0.04）和CTA Tan (aOR 3.71, p <；0.01)为ASITN≥3的显著预测因子。结论dCTA与良好的DSA侧支评分相关，可能有助于AIS大血管闭塞患者的临床决策。进一步的研究可以评估其在预后预测中的作用。
Single- and Multiphase CT Angiography Is Associated With Digital Subtraction Angiography Collateral Score ≥3
Background and Purpose
Collateral status is an important predictor of reperfusion and mortality in patients with large vessel anterior circulation acute ischemic stroke (AIS). We assess the utility of multiphase computed tomography angiography (CTA) derived from CT perfusion (CTP) source imaging (dCTA) in determining collateral status compared to the reference standard American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score on digital subtraction angiography (DSA).
Methods
We retrospectively analyzed AIS patients treated at our institution from January 9, 2017, to January 10, 2023. Inclusion criteria included CTA-confirmed anterior circulation large vessel occlusion, diagnostic CTP, and mechanical thrombectomy with documented DSA collateral score. The modified treatment in cerebral ischemia score was used to assess reperfusion. Logistic regression analyses evaluated associations between demographic and clinical factors, collateral status, ASITN/SIR, and reperfusion status.
Results
A total of 311 patients (mean age 67.35 ± 16.37, 57.4% female) were included. Univariate analysis showed that proximal M2 (PM2) occlusion site (odds ratio [OR] 4.45, p < 0.001), Alberta Stroke Program Early CT Score (OR 1.24, p = 0.006), dCTA (OR 3.81, p < 0.001), and CTA Tan (OR 6.05, p < 0.001) were associated with an ASITN score of ≥3, indicating collateral flow. Multivariate regression, adjusted for race, occlusion site, radiologic features, National Institutes of Health stroke score, and premorbid modified Rankin score, found PM2 occlusion site (aOR 5.99, p < 0.001), dCTA (adjusted OR [aOR] 2.24, p = 0.04), and CTA Tan (aOR 3.71, p < 0.01) to be significant predictors of ASITN ≥3.
Conclusions
dCTA is associated with favorable DSA collateral scores and may aid clinical decision-making in AIS patients with large vessel occlusions. Further studies can assess its role in outcome prediction.
期刊介绍：
Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on:
MRI
CT
Carotid Ultrasound and TCD
SPECT
PET
Endovascular Surgical Neuroradiology
Functional MRI
Xenon CT
and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!
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