Abstract
Objective: This work explores collateral circulation metrics, such as the anterior borderzone angle grading (ABZA-grading), as a predictor of the prognosis in patients with acute middle cerebral artery occlusion (MCAO) following endovascular treatment (EVT).Methods: Clinical data from 108 patients with acute MCAO, treated by EVT, were retrospectively analyzed. In patients with MCAO, ABZA is the angle between the median line of the sagittal sinus and the borderzone of the pial arterioles of ACA and MCA, and the ABZA/23.0° was rounded to obtain the corresponding collateral circulation score (ABZA-grading). In parallel, the primary outcome was defined as the 90-day clinical outcome by modified ranking scale score (mRS). Univariate analysis and logistic regression were used to analyze the independent predictors of the 90-day clinical outcome (mRS). Receiver operating characteristic curve (ROC) analysis was used to judge the predictive value of ABZA.Results: Univariate analysis and logistic regression analysis showed that ABZA-grading > 2 and age were independent predictors of the 90-day clinical outcome after EVT in patients with acute MCAO. The ROC analysis showed that ABZA alone could predict a favorable 90-day clinical outcome with an area under the curve (AUC) of 0.868. Using an ABZA of >57.8° (the corresponding ABZA-grading of >2) as the cut-off value, the predictive sensitivity and specificity were 75.7 and 88.7%, respectively. Contingency table analysis showed a statistical difference in mRS score between ABZA-grading subgroups, and ABZA-grading between stroke caused by large artery atherosclerosis (LAA) and cardiogenic embolism (CE).Conclusion: The ABZA-grading is an easy and objective assessment of collateral circulation that is independently associated with short-time clinical outcome after EVT in patients with acute MCAO. Therefore, it may guide selection of patients with acute ischemic stroke (AIS) suitable for EVT. The ABZA-grading of collateral circulation can be a supplemental metric to help differentiate stroke by LAA and CE.
Highlights
Numerous studies have shown that good collateral circulation is essential to maintain ischemic penumbra, and is associated with smaller infarct cores and improved clinical outcomes after intravenous and intrarterial thrombolysis
The scoring methods based on digital subtraction angiography (DSA) for assessing collateral state include: the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) and the Capillary Index Score (CIS)
We tested the predictive value of this measurement anterior borderzone angle (ABZA) (ABZA-grading), on the prognosis of patients with acute middle cerebral artery occlusion (MCAO) treated by endovascular therapy (EVT)
Summary
Numerous studies have shown that good collateral circulation is essential to maintain ischemic penumbra, and is associated with smaller infarct cores and improved clinical outcomes after intravenous and intrarterial thrombolysis. The scoring methods based on digital subtraction angiography (DSA) for assessing collateral state include: the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) and the Capillary Index Score (CIS). Of these two, ASITN/SIR-grading is most widely used because of its simplicity and operability. Our previous study introduced a new quantitative parameter of anterior borderzone angle (ABZA), to study changes of ACA-MCA boundary area; and exposed its relationship to hemodynamic changes during MCA stenosis and occlusion Together these could be used as a quantitative index to evaluate the compensation of ACA pial collateral [6]. We tested the predictive value of this measurement ABZA (ABZA-grading), on the prognosis of patients with acute middle cerebral artery occlusion (MCAO) treated by EVT
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