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Association of the careggi collateral score with radiological outcomes after thrombectomy for stroke with an occlusion of the middle cerebral artery

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Abstract

We aimed to examine the association between Careggi Collateral Score (CCS) and radiological outcomes in a large multicenter cohort of patients receiving thrombectomy for stroke with occlusion of middle cerebral artery (MCA). We conducted a study on prospectively collected data from 1785 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. According to the extension of the retrograde reperfusion in the cortical anterior cerebral artery-MCA territories, CCS ranges from 0 (absence of retrograde filling) to 4 (visualization of collaterals until the alar segment of the MCA). Radiological outcomes at 24 h were the presence and severity of infarct growth defined by the absolute change in ASPECTS from baseline to 24 h; presence and severity of cerebral bleeding defined as no ICH, HI-1, HI-2, PH-1, or PH-2; presence and severity of cerebral edema (CED) defined as no CED, CED-1, CED-2, or CED-3. Using CCS = 0 as reference, ORs of CCS grades were significantly associated in the direction of better radiological outcome on infarct growth (0.517 for CCS = 1, 0.413 for CCS = 2, 0.358 for CCS = 3, 0.236 for CCS = 4), cerebral bleeding grading (0.485 for CCS = 1, 0.445 for CCS = 2, 0.400 for CCS = 3, 0.379 for CCS = 4), and CED grading (0.734 for CCS = 1, 0.301 for CCS = 2, 0.295 for CCS = 3, 0.255 for CSS = 4) shift in ordinal regression analysis after adjustment for pre-defined variables (age, NIHSS score, ASPECTS, occlusion site, onset-to-groin puncture time, procedure time, and TICI score). Using CCS = 4 as reference, ORs of CCS grades were significantly associated in the direction of worse radiological outcome on infarct growth (1.521 for CCS = 3, 1.754 for CCS = 2, 2.193 for CCS = 1, 4.244 for CCS = 0), cerebral bleeding grading (2.498 for CCS = 0), and CED grading (1.365 for CCS = 2, 2.876 for CCS = 1, 3.916 for CCS = 0) shift. The CCS could improve the prognostic estimate of radiological outcomes in patients receiving thrombectomy for stroke with MCA occlusion.

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Abbreviations

ACA:

Anterior cerebral artery

ASPECTS:

Alberta Stroke Programme Early CT Score

CCS:

Careggi Collateral Score

CED:

Cerebral edema

EVT:

Endovascular treatment

HI-1:

Hemorrhagic infarction type 1

HI-2:

Hemorrhagic infarction type 2

ICA:

Internal carotid artery

ICH:

Intracerebral haemorrhage

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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Acknowledgements

We thank all patients and persons who participated in IRETAS.

Funding

“The project ‘‘Registro Nazionale Trattamento Ictus Acuto’’ (RFPS-2006-1-336562) was funded by grants from the Italian Ministry of Health within the framework of 2006 Finalized Research Programmes (D.Lgs.n.502/1992).

Author information

Author notes

  1. Danilo Toni and Salvatore Mangiafico have 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 & Cecilia Zivelonghi

  2. Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy

    Valentina Saia & Tiziana Tassinari

  3. Neuroscience Section, Department of NEUROFARBA, University of Florence, Florence, Italy

    Giovanni Pracucci & Domenico Inzitari

  4. Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Florence, Italy

    Enrico Fainardi

  5. Stroke Unit, Careggi University Hospital, Florence, Italy

    Patrizia Nencini

  6. Neurology and Stroke Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Laura Malfatto

  7. Stroke Unit, University Hospital of Siena, Siena, Italy

    Rossana Tassi

  8. Stroke Unit, Città della Salute e della Scienza – Molinette, Turin, Italy

    Paolo Cerrato

  9. Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy

    Michelangelo Mancuso

  10. S.C. Neurologia – “SS. Annunziata” Hospital, Taranto, Italy

    Angela Pesare

  11. UOSD Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Paolino La Spina

  12. Stroke Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy

    Enrico Maria Lotti

  13. Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy

    Alfonsina Casalena

  14. UO Neurologia e Stroke Unit, AOU Consorziale Policlinico, Bari, Italy

    Marco Petruzzellis

  15. Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, Padua University Hospital, Padua, Italy

    Claudio Baracchini

  16. Neurology Unit, San Giovanni Bosco Hospital, Turin, Italy

    Alessandra Giai Via

  17. Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy

    Carmen Gaudiano

  18. Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy

    Fabrizio Sallustio

  19. Neurorology Unit, Ospedale dell’Angelo, USSL3 Serenissima, Mestre, Italy

    Adriana Critelli

  20. Neuroscience Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy

    Maurizio Melis

  21. UC Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy

    Alessandra Persico

  22. Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy

    Ilaria Casetta

  23. Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy

    Simona Sacco

  24. Department of Neurology Department, Azienda Ospedaliera “SS Antonio e Biagio e C. Arrigo”, Alessandria, Italy

    Delfina Ferrandi

  25. Humanitas Clinical and Research Center – IRCCS, Rozzano, MI, Italy

    Simona Marcheselli

  26. Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy

    Monia Russo

  27. Neuroradiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    Nicolò Mandruzzato

  28. Stroke Unit, Fondazione Poliambulanza, Brescia, Italy

    Paolo Invernizzi

  29. UOC Neuroradiologia, AUO S. Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy

    Daniele Romano

  30. Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

    Ettore Nicolini & Danilo Toni

  31. Stroke Unit, Ospedale Universitario, Parma, Italy

    Umberto Scoditti

  32. Neurology Unit, Spedali Civili, Brescia, Italy

    Mauro Magoni

  33. Neurologia e Stroke Unit, Ospedale di Circolo-ASST Sette Laghi, Varese, Italy

    Lucia Princiotta Cariddi

  34. Neuroradiology Unit, Department of Neuroscience, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy

    Stefano Vallone

  35. Interventional Neurovascular Unit, Careggi University Hospital, Firenze, Italy

    Salavatore Mangiafico

Authors
  1. Manuel Cappellari
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  2. Valentina Saia
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  3. Giovanni Pracucci
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  8. Paolo Cerrato
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  9. Michelangelo Mancuso
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  10. Angela Pesare
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  14. Marco Petruzzellis
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  37. Domenico Inzitari
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  38. Danilo Toni
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  39. Salavatore Mangiafico
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Consortia

the IRETAS group

Corresponding author

Correspondence to Manuel Cappellari.

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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.

Standard protocol approvals, registrations, and patient consents

Need for ethical approval or patient consent for participation in the IRETAS varied among participating hospitals. Informed consent to use of anonymized and aggregated data for participation in the IRETAS was obtained in all patients of each center.

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Cappellari, M., Saia, V., Pracucci, G. et al. Association of the careggi collateral score with radiological outcomes after thrombectomy for stroke with an occlusion of the middle cerebral artery. J Thromb Thrombolysis 54, 309–317 (2022). https://doi.org/10.1007/s11239-022-02647-z

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