Abstract
Background and PurposeThe presence of good collaterals on CT angiography (CTA) is a well-known predictor for favorable outcome in acute ischemic stroke. Recently, multiphase CT has been introduced as a more accurate method in assessing collaterals. The aim of this study was to assess the ability of dual-phase CT to evaluate collateral status and predict clinical outcome.MethodsForty-three patients who underwent both dual-phase CT and transfemoral cerebral angiography (TFCA) for occluded intracranial internal carotid artery (ICA) and/or middle cerebral artery (M1 segment) were recruited from a prospectively collected database. The collateral status on dual-phase CT was graded by using a 4-point scale: grade 0 = no collaterals; 1 = some collaterals with persistence of some defects; 2 = slow but complete collaterals; and 3 = fast and complete collaterals. Univariate and multivariate analysis were performed to define the independent predictors for favorable outcome at 3 months.ResultsDual-phase CT collateral status (ρ = 0.744) showed higher correlation with TFCA collateral status than CTA collateral status (ρ = 0.596) and substantial interobserver agreement (weighted κ = 0.776). In the univariate analysis, age, history of hypertension, collateral scores on CTA, dual-phase CT, and TFCA, occlusion in intracranial ICA, final infarct volume, and symptomatic hemorrhage were significantly associated with outcome. Among them, only the dual-phase CT collateral score was an independent predictor for favorable outcome (OR = 26.342 (2.788–248.864); P = 0.004) in the multivariate analysis.ConclusionsThe collateral status on dual-phase CT can be a useful predictor for clinical outcome in acute stroke patients, especially when advanced CT techniques are not available in emergent situations.
Highlights
The presence of good collateral circulation to the ischemic territory is a notable predictor for favorable long term clinical outcome as well as small infarct size and good response to treatment in patients with proximal intracranial arterial occlusion [1,2,3,4,5,6]
We empirically found that dual-phase computed tomography (CT) composed of CT angiography (CTA) and delayed contrast enhanced CT (CECT) is helpful for predicting clinical outcome in patients with acute stroke
The pattern of leptomeningeal collaterals on dual-phase CT was associated with the TOAST classification of stroke: cardioembolic infarcts were observed more often in patients with less collaterals than those with large arterial infarcts
Summary
The presence of good collateral circulation to the ischemic territory is a notable predictor for favorable long term clinical outcome as well as small infarct size and good response to treatment in patients with proximal intracranial arterial occlusion [1,2,3,4,5,6]. These beneficial roles may be attributable to preserve downstream perfusion distal to occluded vessels, to permit access of thrombolytic materials to the distal end of the clot by retrograde flow, and to augment washout of emboli in distal arteries [7,8,9]. The aim of this study was to assess the ability of dual-phase CT to evaluate collateral status and predict clinical outcome
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
