Improving Prognostic Evaluation by 4D CTA for Endovascular Treatment in Acute Ischemic Stroke Patients: A Preliminary Study

Abstract

Objective: We aim to use 4D CTA with a comprehensive and objective scoring system to assess collateral circulation, and explore the value of prognosis prediction in endovascular treated patients. Methods: Thirty-four patients with unilateral anterior circulation large vessels occlusion were reviewed in this study retrospectively. Single-phase CTA (sCTA) and 4D CTA acquired by CT perfusion scanning were analyzed for collateral circulation assessment. The collateral vessels were scored 0-4 according to modified collateral circulation scoring based on 4D CTA. Zero to two points indicated poor collateral circulation; 3-4 points indicated good collateral circulation. Good prognosis was defined as modified Rankin scale score of 0-2. Logistic regression was used to analyze the relationship between collateral circulation and prognosis. Results: The mean age was 71.1 ± 11.5 years old. Collateral circulation on 4D CTA was an independent factor for predicting the prognosis (odds ratio = .101; 95% confidence interval: [.101-.924]; P = .042), but sCTA could not predict prognosis (P = .214). 4D CTA collateral circulation scoring had a good predicting efficacy on clinical prognosis (Area Under Curve (AUC) = .936; 95% confidence interval: [.751-.992], P < .005). Patients with good collaterals (4D CTA scores of 3-4) could obtain benefit from endovascular treatment (P = .029) compared with patients with poor collaterals (P = 1.000). Conclusions: 4D CTA could be applied to effectively evaluate cerebral collateral status. The accurate assessment of collateral circulation based on 4D CTA would be helpful to make medical decisions, especially for those patients who would undergo endovascular interventional treatment.