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Collateral Scores in Acute Ischemic Stroke

A retrospective study assessing the suitability of collateral scores as standalone predictors of clinical outcome
  • Fatih Seker
  • Benjamin Pereira-Zimmermann
  • Johannes Pfaff
  • Jan Purrucker
  • Christoph Gumbinger
  • Silvia Schönenberger
  • Martin Bendszus
  • Markus A. MöhlenbruchEmail author
Original Article
  • 29 Downloads

Abstract

Background and Purpose

Several collateral scores have been published for stroke in the middle cerebral artery territory, each considering different aspects of cerebral collateralization. Currently, there is no gold standard in CT-based collateral assessment. The aim of this retrospective study was to compare five collateral scores and determine whether they are able to predict clinical outcome after thrombectomy as standalone parameters.

Methods

Inclusion criteria were M1 occlusion, premorbid modified Rankin scale (mRS) of 0–3, treatment with endovascular thrombectomy and groin puncture within 12 h after stroke onset. The Maas et al., Miteff et al., Tan et al., ASITN/SIR and mCTA collateral scores were retrospectively assessed in multiphase CTA images and correlated with 90-day mRS (90d-mRS) scores. Good outcome was defined as 90d-mRS 0–2 or unchanged to premorbid mRS.

Results

In total, 108 patients were included of which 39.8% achieved a good outcome. The area under the curve (AUC) values of receiver operating characteristic (ROC) curve analysis for Maas et al., Miteff et al., Tan et al., ASITN/SIR and mCTA scores were 0.60 (0.51–0.70), 0.60 (0.52–0.68), 0.61 (0.51–0.70), 0.59 (0.49–0.70) and 0.61 (0.50–0.71), respectively. The correlation between 90d-mRS and Maas (r = −0.16, P = 0.091), Miteff (r = −0.25, P = 0.009), Tan (r = −0.26, P = 0.007), ASITN/SIR (r = −0.21, P = 0.030) and mCTA (r = −0.22, P = 0.021) scores was poor.

Conclusion

Although collaterals are known to correlate with clinical outcome, none of the analyzed collateral scores sufficiently predicted outcome as a standalone parameter.

Keywords

Maas Miteff Tan ASITN/SIR mCTA 

Abbreviations

90d-mRS

Modified Rankin scale score at 90 days

ASITN/SIR

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

AUC

Area under the curve

IQR

Interquartile range

mCTA

Multiphase computed tomography angiography

ROC

Receiver operating characteristic

Notes

Author Contribution

F. Seker, M. Bendszus and M.A. Möhlenbruch conceived the study and initiated the study design. F. Seker, B. Pereira-Zimmermann, J. Pfaff, J. Purrucker, C. Gumbinger and S. Schönenberger contributed to acquisition of data for the work. F. Seker, B. Pereira-Zimmermann, M. Bendszus and M.A. Möhlenbruch contributed to analysis and interpretation of data. All authors contributed to refinement of the study protocol and reviewed and approved the final manuscript.

Funding

B. Pereira-Zimmermann received funding from the Ministry of Education and University of Valparaiso in Chile.

Compliance with ethical guidelines

Conflict of interest

F. Seker, J. Pfaff, J. Purrucker, C. Gumbinger, S. Schönenberger, M. Bendszus and M.A. Möhlenbruch declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

62_2019_858_MOESM1_ESM.docx (11 kb)
Figure 1. Box plots demonstrating 90 day modified Rankin Scale (90d-mRS) scores for every score point on Maas, Miteff, Tan, ASITN/SIR and mCTA collateral scores.
62_2019_858_MOESM2_ESM.tiff (253 kb)
Tables 1–5 are describing Maas, Miteff, Tan, ASITN/SIR and mCTA collateral scores.

References

  1. 1.
    Bang OY, Saver JL, Buck BH, Alger JR, Starkman S, Ovbiagele B, et al. Impact of collateral flow on tissue fate in acute ischaemic stroke. J Neurol Neurosurg Psychiatry. 2008;79:625–9.CrossRefGoogle Scholar
  2. 2.
    Pham M, Bendszus M. Facing time in ischemic stroke: an alternative hypothesis for collateral failure. Clin Neuroradiol. 2016;26:1–11.CrossRefGoogle Scholar
  3. 3.
    Goyal M, Menon BK, Derdeyn CP. Perfusion imaging in acute ischemic stroke: let us improve the science before changing clinical practice. Radiology. 2013;266:16–21.CrossRefGoogle Scholar
  4. 4.
    McVerry F, Liebeskind DS, Muir KW. Systematic review of methods for assessing Leptomeningeal collateral flow. AJNR Am J Neuroradiol. 2012;33:576–82.CrossRefGoogle Scholar
  5. 5.
    Seker F, Potreck A, Möhlenbruch M, Bendszus M, Pham M. Comparison of four different collateral scores in acute ischemic stroke by CT angiography. J Neurointerv Surg. 2016;8:1116–8.CrossRefGoogle Scholar
  6. 6.
    Potreck A, Seker F, Hoffmann A, Pfaff J, Nagel S, Bendszus M, et al. A novel method to assess pial collateralization from stroke perfusion MRI: subdividing Tmax into anatomical compartments. Eur Radiol. 2017;27:618–26.CrossRefGoogle Scholar
  7. 7.
    Frölich AM, Schrader D, Klotz E, Schramm R, Wasser K, Knauth M, et al. 4D CT angiography more closely defines Intracranial thrombus burden than single-phase CT angiography. AJNR Am J Neuroradiol. 2013;34:1908–13.CrossRefGoogle Scholar
  8. 8.
    Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS, et al. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke. 2009;40:3001–5.CrossRefGoogle Scholar
  9. 9.
    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;132:2231–8.CrossRefGoogle Scholar
  10. 10.
    Tan IY, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K, et al. 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
  11. 11.
    Higashida RT, Furlan AJ. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34:e109–37.CrossRefGoogle Scholar
  12. 12.
    Menon BK, d’Esterre CD, Qazi EM, Almekhlafi M, Hahn L, Demchuk AM, et al. Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke. Radiology. 2015;275:510–20.CrossRefGoogle Scholar
  13. 13.
    Seker F, Potreck A, Möhlenbruch M, Bendszus M, Pham M. Comparison of four different collateral scores in acute ischemic stroke by CT angiography. J Neurointerv Surg. 2016;8:1116–8.CrossRefGoogle Scholar
  14. 14.
    Elijovich L, Goyal N, Mainali S, Hoit D, Arthur AS, Whitehead M, et al. CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review. J Neurointerv Surg. 2016;8:559–62.CrossRefGoogle Scholar
  15. 15.
    Ginsberg MD. The cerebral collateral circulation: relevance to pathophysiology and treatment of stroke. Neuropharmacology. 2018;134:280–92.CrossRefGoogle Scholar
  16. 16.
    Bang OY, Goyal M, Liebeskind DS. Collateral circulation in ischemic stroke. Stroke. 2015;46:3302–9.CrossRefGoogle Scholar
  17. 17.
    Leng X, Fang H, Leung TW, Mao C, Xu Y, Miao Z, et al. Impact of collateral status on successful revascularization in endovascular treatment: a systematic review and meta-analysis. Cerebrovasc Dis. 2016;41:27–34.CrossRefGoogle Scholar
  18. 18.
    Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, et al. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol. 2018;17:895–904.CrossRefGoogle Scholar
  19. 19.
    Arenillas JF, Cortijo E, García-Bermejo P, Levy EI, Jahan R, Liebeskind D, et al. Relative cerebral blood volume is associated with collateral status and infarct growth in stroke patients in SWIFT PRIME. J Cereb Blood Flow Metab. 2018;38:1839–47.CrossRefGoogle Scholar
  20. 20.
    Seker F, Pfaff J, Potreck A, Mundiyanapurath S, Ringleb PA, Bendszus M, et al. Correlation of Tmax volumes with clinical outcome in anterior circulation stroke. Brain Behav. 2017;7:e772.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Fatih Seker
    • 1
  • Benjamin Pereira-Zimmermann
    • 2
  • Johannes Pfaff
    • 1
  • Jan Purrucker
    • 3
  • Christoph Gumbinger
    • 3
  • Silvia Schönenberger
    • 3
  • Martin Bendszus
    • 1
  • Markus A. Möhlenbruch
    • 1
    Email author
  1. 1.Department of NeuroradiologyHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of RadiologyUniversity of ValparaisoValparaisoChile
  3. 3.Department of NeurologyHeidelberg University HospitalHeidelbergGermany

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