J Clin Neurol.  2017 Apr;13(2):121-128. 10.3988/jcn.2017.13.2.121.

CT Angiography of Collateral Vessels and Outcomes in Endovascular-Treated Acute Ischemic Stroke Patients

Affiliations
  • 1Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea. Kim.BJ.Stroke@gmail.com
  • 2Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 4Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

BACKGROUND AND PURPOSE
Measuring the extent of the collateral blood vessels using computed tomography (CT) angiography source images may promote tissue survival and functional gain in acute ischemic stroke patients who are candidates for endovascular recanalization treatment.
METHODS
Of 5,558 acute stroke patients registered in a prospective clinical stroke registry, 104 met the selection criteria of endovascular recanalization treatment for internal cerebral artery or middle cerebral artery main-stem (M1) occlusions and presented for treatment ≤4 hours after the event. Using CT angiography source images, two independent and blinded reviewers measured the extent of collateral circulations at four regions, with good interrater reliability. The functional recovery at 3 months after stroke was used as an outcome variable.
RESULTS
Cases with a sufficient collateral circulation at the Sylvian fissure showed significantly increased likelihood of having a modified Rankin Scale score of ≤2 at 3 months after stroke (adjusted odds ratio=3.03, 95% confidence interval=1.19-7.73, p=0.02), but the association became nonsignificant after adding the infarct volume to the model (p=0.65). The association between leptomeningeal convexity collaterals and functional recovery was no longer significant after adjusting for the infarct volume (p=0.28). The natural indirect effect of infarct volume on functional recovery was significant for both the Sylvian fissure (p=0.03) and leptomeningeal convexity (p=0.02) collaterals.
CONCLUSIONS
The extent of collateral circulation at the Sylvian fissure was significantly associated with functional recovery, which may be mediated via the volume of the final infarction.

Keyword

acute ischemic stroke; collateral; endovascular recanalization; mortality; infarct

MeSH Terms

Angiography*
Blood Vessels
Cerebral Arteries
Collateral Circulation
Humans
Infarction
Middle Cerebral Artery
Mortality
Patient Selection
Prospective Studies
Stroke*
Tissue Survival

Figure

  • Fig. 1 Illustrative cases depicting the collateral status. CBF: cerebral blood flow, MTT: mean transit time.


Reference

1. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015; 372:2296–2306. PMID: 25882510.
Article
2. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015; 372:2285–2295. PMID: 25882376.
Article
3. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015; 372:1019–1030. PMID: 25671798.
4. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusionimaging selection. N Engl J Med. 2015; 372:1009–1018. PMID: 25671797.
Article
5. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015; 372:11–20. PMID: 25517348.
6. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015; 46:3020–3035. PMID: 26123479.
Article
7. 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(Pt 8):2231–2238. PMID: 19509116.
Article
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; 40:3001–3005. PMID: 19590055.
Article
9. Lima FO, Furie KL, Silva GS, Lev MH, Camargo EC, Singhal AB, et al. The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke. 2010; 41:2316–2322. PMID: 20829514.
Article
10. Bhatia R, Bal SS, Shobha N, Menon BK, Tymchuk S, Puetz V, et al. CT angiographic source images predict outcome and final infarct volume better than noncontrast CT in proximal vascular occlusions. Stroke. 2011; 42:1575–1580. PMID: 21566239.
Article
11. Menon BK, Smith EE, Modi J, Patel SK, Bhatia R, Watson TW, et al. Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions. AJNR Am J Neuroradiol. 2011; 32:1640–1645. PMID: 21799045.
Article
12. Brozici M, van der Zwan A, Hillen B. Anatomy and functionality of leptomeningeal anastomoses: a review. Stroke. 2003; 34:2750–2762. PMID: 14576375.
13. Shuaib A, Butcher K, Mohammad AA, Saqqur M, Liebeskind DS. Collateral blood vessels in acute ischaemic stroke: a potential therapeutic target. Lancet Neurol. 2011; 10:909–921. PMID: 21939900.
Article
14. Liebeskind DS, Tomsick TA, Foster LD, Yeatts SD, Carrozzella J, Demchuk AM, et al. Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial. Stroke. 2014; 45:759–764. PMID: 24473178.
Article
15. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. 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. 2013; 44:870–947. PMID: 23370205.
16. Hong KS, Ko SB, Yu KH, Jung C, Park SQ, Kim BM, et al. Update of the Korean clinical practice guidelines for endovascular recanalization therapy in patients with acute ischemic stroke. J Stroke. 2016; 18:102–113. PMID: 26846761.
Article
17. Whitworth JA. World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003; 21:1983–1992. PMID: 14597836.
18. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012; 35(Suppl 1):S64–S71. PMID: 22187472.
19. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143–3421. PMID: 12485966.
20. Tomsick T, Broderick J, Carrozella J, Khatri P, Hill M, Palesch Y, et al. Revascularization results in the interventional management of stroke II trial. AJNR Am J Neuroradiol. 2008; 29:582–587. PMID: 18337393.
Article
21. Valeri L, VanderWeele TJ. Mediation analysis allowing for exposuremediator interactions and causal interpretation: theoretical assumptions and implementation with SAS and SPSS macros. Psychol Methods. 2013; 18:137–150. PMID: 23379553.
Article
22. VanderWeele TJ. Explanation in Causal Inference : Methods for Mediation and Interaction. New York: Oxford University Press;2015.
23. Kim BJ, Han MK, Park TH, Park SS, Lee KB, Lee BC, et al. Trends in the effectiveness of endovascular recanalization for acute stroke: is a change taking place. J Stroke Cerebrovasc Dis. 2015; 24:866–873. PMID: 25726023.
Article
24. McVerry F, Liebeskind DS, Muir KW. Systematic review of methods for assessing leptomeningeal collateral flow. AJNR Am J Neuroradiol. 2012; 33:576–582. PMID: 22135128.
Article
25. Calleja AI, Cortijo E, García-Bermejo P, Gómez RD, Pérez-Fernández S, Del Monte JM, et al. Collateral circulation on perfusion-computed tomography-source images predicts the response to stroke intravenous thrombolysis. Eur J Neurol. 2013; 20:795–802. PMID: 23278976.
Article
26. Lum C, Ahmed ME, Patro S, Thornhill R, Hogan M, Iancu D, et al. Computed tomographic angiography and cerebral blood volume can predict final infarct volume and outcome after recanalization. Stroke. 2014; 45:2683–2688. PMID: 25104844.
Article
27. Kety SS, Schmidt CF. The nitrous oxide method for the quantitative determination of cerebral blood flow in man: theory, procedure and normal values. J Clin Invest. 1948; 27:476–483. PMID: 16695568.
28. Astrup J, Siesjö BK, Symon L. Thresholds in cerebral ischemia-the ischemic penumbra. Stroke. 1981; 12:723–725. PMID: 6272455.
29. Jones TH, Morawetz RB, Crowell RM, Marcoux FW, FitzGibbon SJ, DeGirolami U, et al. Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg. 1981; 54:773–782. PMID: 7241187.
Article
30. Cho TH, Nighoghossian N, Mikkelsen IK, Derex L, Hermier M, Pedraza S, et al. Reperfusion within 6 hours outperforms recanalization in predicting penumbra salvage, lesion growth, final infarct, and clinical outcome. Stroke. 2015; 46:1582–1589. PMID: 25908463.
Article
Full Text Links
  • JCN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr