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Time-resolved CT assessment of collaterals as imaging biomarkers to predict clinical outcomes in acute ischemic stroke

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

Collateral circulation plays a pivotal role in the pathophysiology of acute ischemic stroke and is increasingly recognized as a promising biomarker for predicting the clinical outcome. However, there is no single established grading system. We designed a novel machine-learning software that allows non-invasive, objective, and quantitative assessment of collaterals according to their vascular territories. Our goal is to investigate the prognostic and predictive value of this collateral score for the prediction of acute stroke outcome.

Methods

This is a retrospective study of 135 patients with anterior circulation stroke treated with IV TPA. An equation using this collateral score (adjusting for age, baseline NIHSS, and recanalization) was derived to predict the clinical outcome (90-day mRS). The primary analyses focused on determining the prognostic value of our newly developed collateral scores. Secondary analyses examined the interrelationships between the collateral score and other variables.

Results

The collateral score emerged as a statistically significant prognostic biomarker for good clinical outcome (p < 0.033) among recanalized patients, but not among non-recanalized patients (p < 0.497). Our results also showed that collateral score was a predictive biomarker (p < 0.044). These results suggest that (1) patients with good collateral score derive more benefit from successful recanalization than patients with poor collateral score and (2) collateral status is inconsequential if recanalization is not achieved.

Conclusion

Our data results reinforce the importance of careful patient selection for recanalization therapy to avoid futile recanalization. The paucity of collaterals predicts poor clinical outcome despite recanalization. On the other hand, robust collaterals warrant consideration for recanalization therapy given the better odds of good clinical outcome.

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Authors and Affiliations

  1. Department of Neuroradiology, University of California, San Francisco, CA, USA

    Elizabeth Tong

  2. Department of Radiology, University of Virginia, Charlottesville, VA, USA

    Jim Patrie & Avery Evans

  3. Department of Orthopedics, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong

    Sara Tong

  4. Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland

    Patrik Michel & Ashraf Eskandari

  5. Department of Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA

    Max Wintermark

Authors
  1. Elizabeth Tong
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  2. Jim Patrie
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  3. Sara Tong
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  4. Avery Evans
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  5. Patrik Michel
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  6. Ashraf Eskandari
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  7. Max Wintermark
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Corresponding author

Correspondence to Elizabeth Tong.

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Funding

This study was funded by RSNA Research Resident Grant no. RR1570 and NIH T32 Grant no. T32EB001631.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Tong, E., Patrie, J., Tong, S. et al. Time-resolved CT assessment of collaterals as imaging biomarkers to predict clinical outcomes in acute ischemic stroke. Neuroradiology 59, 1101–1109 (2017). https://doi.org/10.1007/s00234-017-1914-z

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  • DOI: https://doi.org/10.1007/s00234-017-1914-z

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