Leptomeningeal Collateral Supply in Ischemic Stroke Patients: a Comparison of Single-phase Ct-angiography, Multiphase Ct-angiography, Ct-perfusion and Digital Subtraction Angiography
Year: 2019
Type: other
Abstract: Background and purpose Good collateral circulation correlates with good outcomes after endovascular treatment of acute ischemic stroke (AIS). We compared assessment of collaterals by single-phase CT-angiography (CTA) and perfusion-CT derived three-phase CTA, multiphase CTA and temporal maximum intensity projection (tMIP) images to digital subtraction angiography (DSA).MethodsConsecutive patients with AIS who underwent perfusion-CT, CTA, and DSA prior to thrombectomy with occlusion of either the internal carotid artery, or the M1 or M2 segments of the middle cerebral artery were included. Two observers assessed all CT images and one separate observer assessed DSA (reference standard) by using static (Tan et al. 2009) and dynamic (modified ASITN) collateral grading methods. Interobserver agreement was calculated using Cohenu2019s weighted kappa. Concordance between CT and DSA was evaluated with the concordance correlation coefficient (CCC). Associations between imaging assessments and favorable clinical outcome (90-day modified Rankin Scale <3) were evaluated with binary logistic regression.Results Interobserver agreement (n=101) was 0.46 (tMIP), 0.58 (three-phase CTA), 0.67 (multiphase CTA) and 0.69 (single-phase CTA) for static assessments and 0.52 (three-phase CTA) and 0.54 (multiphase CTA) for dynamic assessments. CCC (n=80) was 0.08 (three-phase CTA), 0.09 (single-phase CTA) and 0.23 (multiphase CTA) for static assessments and 0.10 (three-phase CTA) and 0.27 (multiphase CTA) for dynamic assessments. Higher static collateral scores on multiphase CTA (OR 1.7, 95%-CI:1.1-2.7) and tMIP images (OR 2.0, 95%-CI:1.1-3.4) were associated with favorable clinical outcome as were higher mASITN scores on three-phase CTA (OR 1.5, 95%-CI:1.1-2.2) and multiphase CTA (OR 1.7, 95%-CI:1.1-2.6).Conclusion Concordance between collateral assessments on CT and DSA was poor. Collateral status evaluated on PCT derived three-phase CTA and multiphase CTA was associated with clinical outcome, which was not the case for DSA.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4246660389