Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome

Yabalak, Ahmet; Ögün, Muhammed Nur; Önalan, Ayşenur; Yılmaz, Murat; Tokmak, Hilmiye; Ersoy, Sadettin; Bilgili, Fatma; Bakkal, Tahsin

doi:10.1055/s-0044-1779268

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Original Article • Arq. Neuro-Psiquiatr. 82 (3) • 2024 • https://doi.org/10.1055/s-0044-1779268 copy

Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome

Avaliação da relação entre escores colaterais da angiotomografia computadorizada e evolução clínica

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies.

Objective

In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used.

Methods

Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated.

Results

Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS ≤ 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis.

Conclusion

mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.

Keywords
Stroke; Collateral Circulation; Endovascular Procedures; Thrombectomy; Computed Tomography Angiography

	Good clinical outcome (37)	Poor clinical outcome (31)	p
Age	71.16 ± 11.6	75.93 ± 10.89	0.088
Gender M/F	16/21	12/19	0.705
R/L	18/19	16/15	0.808
Occlusion site	M1: 28 ICA distal:3 Tandem: 6	M1: 20 ICA distal:7 Tandem: 4	0.243
Admission NIHSS	13.13 ± 4.42	15.83 ± 5.86	0.034^* * Note: p< 0.05.
ASPECTS	9 (7-10)	9 (5-10)	0.058
Onset-door time	214.81 ± 273.84	213.22 ± 247.84	0.980
Puncture-recanalization time	54.05 ± 38.09	73.58 ± 39.06	0.041^* * Note: p< 0.05.
Onset-recanalization time	346.67 ± 279.05	387.16 ± 253.68	0.537
Number of Passes	2.40 ± 1.51	3.09 ± 1.86	0.097
First pass recanalization	18	8	0.054
sICH	3	4	0.517
Successful recanalization (Tıcı≥2b)	35	23	0.035^* * Note: p< 0.05.
Tan	2 (1-3)	1 (1-3)	0.314
Miteff	2 (1-3)	2 (1-3)	0.119
Maas	2 (2-4)	2 (1-4)	0.308
rLMC	15 (4-19)	12(3-18)	0.019*
mCTA	3 (2-5)	2 (1-5)	0.018^* * Note: p< 0.05.

		Age	NIHSS	ASPECTS	Tan	Maas	rLMC	mCTA	Onset-rec.	Puncture rec.
3rd month mRS	r	0.240	0.314	-0.232	-0.158	-0.138	-0.266	-0.263	0.278	0.328
3rd month mRS	p	0.048^* * Note: p< 0.05.	0.009^* * Note: p< 0.05.	0.057	0.197	0.262	0.028^* * Note: p< 0.05.	0.030^* * Note: p< 0.05.	0.022^* * Note: p< 0.05.	0.006^* * Note: p< 0.05.

	B value	p
Age	0.039	0.092
Gender	-0.188	0.705
NIHSS	0.104	0.038^* * Note: p <0.05.
ASPECT	-0.412	0.065
Tan	-0.326	0.309
Miteff	-0.546	0.120
Maas	-0.446	0.305
rLMC	-0.154	0.024^* * Note: p <0.05.
mCTA	-0.547	0.022^* * Note: p <0.05.

	B	p
Age	0.036	0.159
ASPECT	-0.341	0.161
NIHSS	0.053	0.349
mCTA	-0.321	0.225

	B	p
Age	0.041	0.116
ASPECTS	-0.330	0.177
NIHSS	0.053	0.338
rLMC	-0.109	0.147

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

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[1] Address for correspondence Ahmet Yabalak (email yabalakahmet@gmail.com)

Maas ¹⁰10 MaasMB, LevMH, Ay H, et al. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke 2009;40(09): 3001–3005	1: There is no vessel opacification in the affected MCA territory 2: Vessel opacification is lower compared with the opposite side 3: Both MCA territories are opacified similarly 4: Opacification of the affected MCA territory is higher compared with the opposite side 5: Opacification of the affected MCA territory is exuberant
Tan ¹¹11 Tan JC, Dillon WP, Liu S, Adler F, Smith WS, Wintermark M. Systematic comparison of perfusion-CT and CT-angiography in acute stroke patients. Ann Neurol 2007;61(06):533–543	0: Absent collateral supply to the occluded MCA territory 1: Collateral supply filling <50% but >0% of the occluded MCA territory 2: Collateral supply filling >50% but <100% of the occluded MCA territory 3: Collateral supply filling 100% of the occluded MCA territory
rLMC ¹²12 Menon BK, Smith EE, Modi J, et al. Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions. AJNR Am J Neuroradiol 2011;32(09):1640–1645	rLMC score is based on scoring pial and lenticulostriate arteries (0, no; 1, less; 2, equal or more prominent compared with matching region in opposite hemisphere) in 6 ASPECTS regions (M1–6) plus anterior cerebral artery region and basal ganglia. Pial arteries in the Sylvian sulcus are scored 0, 2, or 4.
mCTA ¹³13 Menon BK, d’Esterre CD, Qazi EM, et al. Multiphase CT Angiography: A New Tool for the Imaging Triage of Patients with Acute Ischemic Stroke. Radiology 2015;275(02):510–520	0: No vessels visible in any phase within the ischemic vascular territory 1: Only a few vessels are visible in any phase within the occluded vascular territory 2: Either a delay of two phases in the filling of the peripheral vessels which decreased the prominence and extent or a one-phase delay and some ischemic regions with no vessels 3: Either a delay of two phases in the filling of the peripheral vessels or the presence of a one-phase delay and significantly reduced number of vessels in the ischemic territory 4: The presence of a delay of one phase in the filling of the peripheral vessels, with equal prominence and extent 5: Either no delay or normal/increased prominence of the pial vessels/normal extent within the ischemic territory in the symptomatic hemisphere
Miteff ¹⁴14 Miteff F, Levi CR, Bateman GA, Spratt N, McElduff P, Parsons MW. The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke. Brain 2009;132(Pt 8):2231–2238	1: Only distal superficial MCA branches are reconstituted 2: Some vessels in the Sylvian fissure show opacification 3: The entire MCA distal to the occlusion is reconstituted