Abstract
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.
Highlights
Ischemic stroke is frequently caused by an acute vessel occlusion leading to brain parenchymal oligemia or ischemia
We investigated the effect and association of CT angiography (CTA)-collaterals and reperfusion on outcome in patients with ischemic stroke due to large vessel occlusion in the anterior circulation having been treated with endovascular therapy (EVT)
According to our institutional protocol, EVT was performed if (1) an intracranial hemorrhage was excluded on noncontrast CT (NCCT), (2) the extent of early ischemic changes on NCCT was smaller than 1/3 of the middle cerebral artery territory, and (3) an intracranial large vessel occlusion was detectable on CTA
Summary
Ischemic stroke is frequently caused by an acute vessel occlusion leading to brain parenchymal oligemia or ischemia. Pial collaterals have been recognized as a prognostic factor for favorable clinical outcome in ischemic stroke patients (Liebeskind 2003; McVerry et al 2012), as they can temporarily compensate regional ischemia to a level that allows tissue survival (Astrup et al 1979). Pial collaterals can best be visualized by digital subtraction angiography (DSA; Von Kummer et al 1995; Kucinski et al 2003). The assessment of collateral status on pretreatment CT angiography (CTA) has been proposed (Schramm et al 2002; Tan et al 2007; Miteff et al 2009). In contrast to DSA (Higashida et al 2003), no generally accepted grading system exists so far for the assessment of collaterals on CTA (McVerry et al 2012)
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