Impact of Collateral Filling Delay on the Development of Subacute Complications After Acute Ischemic Stroke
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Leptomeningeal collaterals play a pivotal role in acute ischemic stroke. While most collateral scores rely on subjective visual analysis, an objective quantification is possible using dynamic computed tomography (CT) angiography (dynCTA). The aim was to determine the value of collateral filling delay (CFD) as assessed by dynCTA for predicting subacute stroke complications.
All subjects with isolated prebifurcation middle cerebral artery M1 occlusions were selected from an initial cohort of 2635 patients who underwent multiparametric CT for suspected stroke. The CFD was defined as the difference in time to peak enhancement between M2 segments of both hemispheres. Logistic regression analysis of CFD for space-occupying infarction (≥5 mm shift of brain tissue over the midline), parenchymal hematoma, and hemorrhagic transformation on follow-up imaging was performed.
In this study 78 patients (47 female, median age 74 years) were included. The median CFD was 6.31 s (interquartile range [IQR] 4.00–8.64). The CFD values were correlated with qualitative collateral scores (p < 0.05). Higher CFD was associated with the development of space-occupying infarction in univariable (odds ratio, OR = 1.28; p = 0.002) and multivariable regression analysis (OR = 1.48; p = 0.004). The CFD had no association with parenchymal hematoma or hemorrhagic transformation (p > 0.05).
A high CFD may serve as reproducible measure for collateralization and indicate development of increased risk of space-occupying infarction.
KeywordsCollateralization Ischemic stroke Anterior circulation Dynamic CT angiography Malignant infarction Space-occupying infarction
Conflict of interest
M.F. Froelich, K.M. Thierfelder, L.T. Rotkopf, M.P. Fabritius, L. Kellert, S. Tiedt, W.H. Sommer, F.A. Wollenweber, F. Dorn, T. Liebig, P. Reidler and W.G. Kunz declare that they have no competing interests.
- 2.Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell PM, Bousser MG, van der Worp HB, Hacke W; DECIMAL, DESTINY, and HAMLET investigators. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6:215–22.CrossRefGoogle Scholar
- 4.Menon BK, Qazi E, Nambiar V, Foster LD, Yeatts SD, Liebeskind D, Jovin TG, Goyal M, Hill MD, Tomsick TA, Broderick JP, Demchuk AM; Interventional Management of Stroke III Investigators. Differential effect of baseline computed tomographic angiography collaterals on clinical outcome in patients enrolled in the Interventional Management of Stroke III trial. Stroke. 2015;46:1239–44.CrossRefGoogle Scholar
- 6.Tan IY, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K, Martin M, Symons SP, Fox AJ, Aviv RI. CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol. 2009;30:525–31.CrossRefGoogle Scholar
- 9.Beyer SE, von Baumgarten L, Thierfelder KM, Rottenkolber M, Janssen H, Dichgans M, Johnson TR, Straube A, Ertl-Wagner B, Reiser MF, Sommer WH. Predictive value of the velocity of collateral filling in patients with acute ischemic stroke. J Cereb Blood Flow Metab. 2015;35:206–12.CrossRefGoogle Scholar
- 10.Horsch AD, Dankbaar JW, Stemerdink TA, Bennink E, van Seeters T, Kappelle LJ, Hofmeijer J, de Jong HW, van der Graaf Y, Velthuis BK; DUST investigators. Imaging findings associated with space-occupying edema in patients with large middle cerebral artery infarcts. AJNR Am J Neuroradiol. 2016;37:831–7.CrossRefGoogle Scholar
- 12.R Development Core Team, R Core Team. R: a language and environment for statistical computing. Vienna; 2008. Available online at https://www.R-project.org/.
- 16.Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American stroke association. Stroke. 2018;49:e46-110.CrossRefGoogle Scholar
- 17.Hom J, Dankbaar JW, Soares BP, Schneider T, Cheng SC, Bredno J, Lau BC, Smith W, Dillon WP, Wintermark M. Blood-brain barrier permeability assessed by perfusion ct predicts symptomatic hemorrhagic transformation and malignant edema in acute ischemic stroke. AJNR Am J Neuroradiol. 2011;32:41–8.CrossRefGoogle Scholar
- 23.Agarwal S, Bivard A, Warburton E, Parsons M, Levi C. Collateral response modulates the time–penumbra relationship in proximal arterial occlusions. Baillieres Clin Neurol. 2018;90:e316–22.Google Scholar
- 25.Kimberly WT, Dutra BG, Boers AMM, Alves HCBR, Berkhemer OA, van den Berg L, Sheth KN, Roos YBWEM, van der Lugt A, Beenen LFM, Dippel DWJ, van Zwam WH, van Oostenbrugge RJ, Lingsma HF, Marquering H, Majoie CBLM; MR CLEAN Investigators. Association of reperfusion with brain edema in patients with acute ischemic stroke. JAMA Neurol. 2018;75:453-61.CrossRefGoogle Scholar
- 26.Berkhemer OA, Jansen IG, Beumer D, Fransen PS, van den Berg LA, Yoo AJ, Lingsma HF, Sprengers ME, Jenniskens SF, Lycklama À, Nijeholt GJ, van Walderveen MA, van den Berg R, Bot JC, Beenen LF, Boers AM, Slump CH, Roos YB, van Oostenbrugge RJ, Dippel DW, van der Lugt A, van Zwam WH, Marquering HA, Majoie CB; MR CLEAN Investigators. Collateral status on baseline computed tomographic angiography and intra-arterial treatment effect in patients with proximal anterior circulation stroke. Stroke. 2016;47:768–76.CrossRefGoogle Scholar