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Favourable collaterals according to the Careggi Collateral Score grading system in patients treated with thrombectomy for stroke with middle cerebral artery occlusion

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Abstract

The ability of the current grading systems to predict optimal outcomes in stroke patients with favourable collaterals remains unexplored. We evaluated differences in the performance of grading systems between Careggi Collateral Score and ASITN/SIR collateral score to predict clinical and radiological outcomes in stroke patients with favourable collaterals who underwent thrombectomy. We included stroke patients receiving thrombectomy within 360 min after symptom onset with MCA occlusion and favourable collaterals (i.e., without poor collaterals) defined by ASITN/SIR collateral score between 2 and 4. Using ordinal regression, we estimated the association of each CCS and ASITN/SIR grade with mRS shift (0–6) at 3 months, NIHSS score (0–42) and ASPECT score (10–0) at baseline, TICI score (3–0), infarct growth, cerebral bleeding, and cerebral edema grading at 24 h by calculating the odds ratios (ORs) with two-sided 95% confidence intervals after adjustment for predefined variables. Using the best collateral grade (CCS = 4) as reference, ORs of the CCS grades were associated in the direction of unfavourable outcome on 3-month mRS shift (2.325 for CCS = 3; 5.092 for CCS = 2), in the direction of more severe baseline NIHSS score (5.434 for CCS = 3; 16.041 for CCS = 2), 24-h infarct growth (2.659 for CCS = 3; 8.288 for CCS = 4) and 24-h cerebral edema (1.057 for CCS = 3; 5.374 for CCS = 2) shift. ORs of the ASITN/SIR grades were associated in the direction of more severe baseline NIHSS score (4.332 for ASITN/SIR = 3; 16.960 for ASITN/SIR = 2) and 24-h infarct growth (2.138 for ASITN/SIR = 3; 7.490 for ASITN/SIR = 2) shift. The AUC ROC of CCS and ASITN/SIR for predicting 3-month mRS score 0–1 were 0.681 (95% CI: 0.562–0.799; p = 0.009) and 0.599 (95% CI: 0.466–0.73; p = 0.156), respectively. CCS = 4 and ASITN/SIR ≥ 3 were the optimal cut-offs to predict 3-month mRS score 0–1, respectively. CCS grading system performed better than the ASITN/SIR collateral score predicting 3-month mRS score and 24-h CED grading in stroke patients with favourable collaterals who received thrombectomy for MCA occlusion.

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Data availability

Anonymized data will be shared upon reasonable request from any qualified investigator.

Abbreviations

ACA:

Anterior cerebral artery

ASPECTS:

Alberta Stroke Programme Early CT Score

CCS:

Careggi Collateral Score

ASITN/SIR:

American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology

CED:

Cerebral edema

EVT:

Endovascular treatment

HI-1:

Hemorrhagic infarction type 1

HI-2:

Hemorrhagic infarction type 2

ICA:

Internal carotid artery

ICH:

Intracerebral hemorrhage

IRETAS:

Italian Registry of Endovascular Treatment in Acute Stroke

MCA:

Middle cerebral artery

mRS:

Modified Rankin Scale

MT:

Mechanical thrombectomy

NIHSS:

National Institutes of Health Stroke Scale

OR:

Odd ratio

PH-1:

Parenchymal hemorrhage type 1

PH-2:

Parenchymal hemorrhage type 2

TICI:

Thrombolysis in cerebral infarction

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Author notes

  1. Giulia Sajeva, and Raffaele Augelli both are equally contributing senior authors.

Authors and Affiliations

  1. Stroke Unit, DAI Di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy

    Manuel Cappellari, Giulia Sajeva & Cecilia Zivelonghi

  2. Interventional Neurovascular Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    Raffaele Augelli, Mauro Plebani & Nicolò Mandruzzato

  3. Interventional Neurovascular Unit, Careggi University Hospital, Firenze, FL, Italy

    Salvatore Mangiafico

Authors
  1. Manuel Cappellari
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  2. Giulia Sajeva
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  3. Raffaele Augelli
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  4. Cecilia Zivelonghi
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  5. Mauro Plebani
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  6. Nicolò Mandruzzato
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  7. Salvatore Mangiafico
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Correspondence to Manuel Cappellari.

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Cappellari, M., Sajeva, G., Augelli, R. et al. Favourable collaterals according to the Careggi Collateral Score grading system in patients treated with thrombectomy for stroke with middle cerebral artery occlusion. J Thromb Thrombolysis 54, 550–557 (2022). https://doi.org/10.1007/s11239-022-02692-8

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  • DOI: https://doi.org/10.1007/s11239-022-02692-8

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