The Prognostic Value of CT-Angiographic Parameters After Reperfusion Therapy in Acute Ischemic Stroke Patients With Internal Carotid Artery Terminus Occlusion: Leptomeningeal Collateral Status and Clot Burden Score.

Publisher: Saunders Country of Publication: United States NLM ID: 9111633 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8511 (Electronic) Linking ISSN: 10523057 NLM ISO Abbreviation: J Stroke Cerebrovasc Dis Subsets: MEDLINE

Publication: Philadelphia, PA : Saunders
Original Publication: New York, NY : Demos Publications, [1991-

Cerebrovascular Circulation* ; Collateral Circulation* ; Endovascular Procedures* ; Predictive Value of Tests*; Brain Ischemia/*therapy ; Carotid Artery, Internal/*diagnostic imaging ; Carotid Stenosis/*therapy ; Cerebral Angiography/*methods ; Meninges/*blood supply ; Stroke/*therapy ; Thrombosis/*therapy; Aged ; Aged, 80 and over ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/physiopathology ; Carotid Stenosis/diagnostic imaging ; Carotid Stenosis/physiopathology ; Chi-Square Distribution ; Computed Tomography Angiography ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Stroke/diagnostic imaging ; Stroke/physiopathology ; Thrombolytic Therapy ; Thrombosis/diagnostic imaging ; Thrombosis/physiopathology ; Time Factors ; Treatment Outcome

Background: The objective of this study was to investigate the prognostic value of computed tomographic angiography (CTA) based on leptomeningeal collateral (LMC) status and other parameters in acute ischemic stroke (AIS) patients with internal carotid artery (ICA) terminus occlusion treated with endovascular treatment (EVT).
Methods: All eligible patients from January 2013 to December 2017 undergoing EVT were retrospectively reviewed. The regional leptomeningeal score was used to assess the LMCs on baseline CTA. The collateral status measured by the LMC score (0-20) was trichotomized into 3 groups: good (17-20), intermediate (11-16), and poor (0-10).
Results: Our sample included a total of 119 eligible patients (60 males; mean age, 73 years) with a median baseline National Institute of Health Stroke Scale (NIHSS) score of 14. Patients with a good LMC score had a lower baseline mean NIHSS score, a higher mean Alberta Stroke Program Early CT score, and a higher mean clot burden score (CBS). Baseline NIHSS score <15 (odds ratio [OR] 3.69 95% confidence ratio [CI]: 1.32-10.29, P = .013), CBS ≥ 6 (OR 3.97 95%CI: 1.05-14.99, P = .042), good LMC score (OR 5.14 95%CI: 1.62-16.26, P = .005) and successful recanalization (OR 11.55 95%CI: 2.72-48.99 P = .001) were independent predictors of good clinical outcomes.
Conclusions: CTA-based LMC status and CBS are powerful predictors of clinical outcomes in patients with an acute ICA terminus occlusion treated with EVT.
(Copyright © 2018. Published by Elsevier Inc.)

Keywords: Leptomeningeal collaterals; acute ischemic stroke; computed tomographic angiography; endovascular treatment

Date Created: 20180802 Date Completed: 20181126 Latest Revision: 20181126

20231215

10.1016/j.jstrokecerebrovasdis.2018.06.010

30064866