Research ArticleBRAIN
CT Angiography Clot Burden Score and Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute Middle Cerebral Artery Infarct
I.Y.L. Tan, A.M. Demchuk, J. Hopyan, L. Zhang, D. Gladstone, K. Wong, M. Martin, S.P. Symons, A.J. Fox and R.I. Aviv
American Journal of Neuroradiology March 2009, 30 (3) 525-531; DOI: https://doi.org/10.3174/ajnr.A1408
I.Y.L. Tan
A.M. Demchuk
J. Hopyan
L. Zhang
D. Gladstone
K. Wong
M. Martin
S.P. Symons
A.J. Fox

References
- ↵Khatri P, Neff J, Broderick JP, et al. Revascularization end points in stroke interventional trials: revascularization versus reperfusion in IMS-I. Stroke 2005;36:2400–03
- ↵Mattle HP, Arnold M, Georgiadis D, et al. Comparison of intraarterial and intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign. Stroke 2008;39:379–83
- ↵Somford DM, Nederkoorn P, Rutgers DR, et al. Proximal and distal hyperattenuating middle cerebral artery signs at CT: different prognostic implications. Radiology 2002;223:667–71
- ↵Bozzao L, Fantozzi LM, Bastianello S, et al. Early collateral blood supply and late parenchymal brain damage in patients with middle cerebral artery occlusion. Stroke 1989;20:735–40
- ↵Gralla J, Burkhardt M, Schroth G, et al. Occlusion length is a crucial determinant of efficiency and complication rate in thrombectomy for acute ischemic stroke. AJNR Am J Neuroradiology 2008;29:247–52
- ↵Rosenthal ES, Schwamm LH, Roccatagliata L, et al. Role of recanalization in acute stroke outcome: rationale for a CT angiogram-based “benefit of recanalization” model. AJNR Am J Neurolradiol 2008;29:1471–75. Epub 2008 Jul 3
- ↵del Zoppo GJ, Higashida RT, Furlan AJ, et al. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke— PROACT Investigators. Prolyse in Acute Cerebral Thromboembolism. Stroke 1998;29:4–11
- ↵del Zoppo GJ, Poeck K, Pessin MS, et al. Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann Neurol 1992;32:78–86
- ↵Kim YS, Garami Z, Mikulik R, et al, for the CLOTBUST Collaborators. Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion. Stroke 2005;36:869–71
- ↵Manelfe C, Larrue V, von Kummer R, et al. Association of hyperdense middle cerebral artery sign with clinical outcome in patients treated with tissue plasminogen activator. Stroke 1999;30:769–72
- ↵Tomsick T, Brott T, Barsan W, et al. Thrombus localization with emergency cerebral CT. AJNR Am J Neuroradiology 1992;13:257–63
- ↵Camargo ECS, Furie KL, Singhal AB, et al. Acute brain infarct: detection and delineation with CT angiographic source images versus nonenhanced CT scans. Radiology 2007;244:541–48
- ↵
- ↵Parsons MW, Pepper EM, Chan V, et al. Perfusion computed tomography: prediction of final infarct extent and stroke outcome. Ann Neurol 2005;58:672–79
- Murphy BD, Fox AJ, Lee DH, et al. White matter thresholds for ischemic penumbra and infarct core in patients with acute stroke: CT perfusion study. Radiology 2008;247:818–25
- Schaefer PW, Roccatagliata L, Ledezma C, et al. First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy. AJNR Am J Neuroradiology 2006;27:20–25
- ↵Murphy BD, Fox AJ, Lee DH, et al. Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements. Stroke 2006;37:1771–77
- ↵Hendrikse J, Hartkamp MJ, Hillen B, et al. Collateral ability of the circle of Willis in patients with unilateral internal carotid artery occlusion: border zone infarcts and clinical symptoms. Stroke 2001;32:2768–73
- ↵Liebeskind DS. Collateral circulation. Stroke 2003;34:2279–84
- ↵Kim JJ, Fischbein NJ, Lu Y, et al. Regional angiographic grading system for collateral flow: correlation with cerebral infarction in patients with middle cerebral artery occlusion. Stroke 2004;35:1340–44
- ↵Kucinski T, Koch C, Eckert B, et al. Collateral circulation is an independent radiological predictor of outcome after thrombolysis in acute ischemic stroke. Neuroradiology 2003;45:11–18
- ↵Tan JC, Dillon WP, Liu S, et al. Systemic comparison of perfusion-CT and CT-angiography in acute stroke patients. Ann Neurol 2007;61:533–43
- ↵Barber PA, Demchuk AM, Zhang J, et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 2000;355:1670–74
- ↵Puetz V, Dzialowski I, Hill MD, et al. Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the Clot Burden Score. Int J Stroke 2008;3:230–36
- ↵Johnson JA, Wilson TA. A model for capillary exchange. Am J Physiol 1966;210:1299–303
- ↵Cenic A, Nabavi DG, Craen RA, et al. Dynamic CT measurement of cerebral blood flow: a validation study. AJNR Am J Neuroradiology 1999;20:63–73
- ↵Hossman K-A. Viability thresholds and the penumbra of focal ischemia. Ann Neurol 1994;36:557–65
- ↵Hacke W, Albers G, Al-Rawi Y, et al. The Desmoteplase in acute Ischemic Stroke Trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke 2005;36:66–73. Epub 2004 Nov 29
- ↵Albers GW, Thijs VN, Wechsler L, et al, for the DEFUSE investigators. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evaluation (DEFUSE) study. Ann Neurol 2006;60:508–17
- ↵Torres-Mozqueda F, He J, Yeh IB, et al. An acute ischemic stroke classification instrument that includes CT or MR angiography: The Boston Acute Stroke Imaging Scale. AJNR Am J Neuroradiology 2008;29:1111–17. Epub 2008 May 8
- Smith WS, Tsao JW, Billings ME, et al. Prognostic significance of angiographically confirmed large vessel intracranial occlusion in patients presenting with acute brain ischemia. Neurocritic Care 2006;4:14–17
- ↵Linfante I, Rafael HL, Magdy S, et al. Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator. Stroke 2002;33:2066–71
- ↵
- ↵Kaste M, Waltimo O. Prognosis of patients with middle cerebral artery occlusion. Stroke 1976;7:482–85
- ↵Flint AC, Duckwiler GR, Budzik RF, et al, for MERCI and Multi Merci Writing Committee. Mechanical Thrombectomy of Intracranial Internal Carotid Occlusion: Pooled results of the MERCI and Multi MERCI Part I Trials. Stroke 2007;38:1274–80. Epub 2007 Mar 1
- ↵Molina CA, Ribo M, Rubiera M, et al. Microbubble administration accelerates clot lysis during continuous 2-MH ultrasound monitoring in stroke patients treated with intravenous tissue plasminogen activator. Stroke 2006;37:425–429. Epub 2005 Dec 22
- ↵Furlan A, Higashida R, Wechsler L, et al. Intra-arterial prourokinase for acute ischemic stroke: The PROACT II study—A randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999;282:2003–11
- ↵Smith WS, Sung G, Starkman S, et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: Results of the MERCI trial. Stroke 2005;36:1432–38
- ↵Harrison MJ, Marshall J. The variable clinical and CT findings after carotid occlusion: the role of collateral supply. J Neurol Neurosurg Psychiatry 1988;51:269–72
- ↵Henderson RD, Eliasziw M, Fox AJ, et al. Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis: North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Stroke 2000;31:128–32
- ↵Astrup J, Siesjo BK, Symon L. Thresholds in cerebral ischemia: the ischemic penumbra. Stroke 1981;12:723–25
- ↵Schramm P, Schellinger PD, Klotz E, et al. Comparison of perfusion computed tomography angiography source images with perfusion-weighted imaging and diffusion-weighted imaging in patients with acute stroke of less than 6 hours’ duration. Stroke 2004;35:1652–8
- ↵Wintermark M, Reichhart M, Cuisenaire O, et al. Comparison of admission perfusion computed tomography and qualitative diffusion- and perfusion-weighted magnetic resonance imaging in acute stroke patients. Stroke 2002;33:2025–31
- ↵Jorgensen HS, Reith J, Nakayama H, et al. What determines good recovery in patients with the most severe strokes? The Copenhagen Stroke Study. Stroke 1999;30:2008–12
- Demchuk AM, Buchan AM. Predictors of stroke outcome. Neurol Clin 2000;19:455–73
- ↵Tei H, Uchiyama S, Usui T. Predictors of good prognosis in total anterior circulation infarction within 6 hours after onset under conventional therapy. Acta Neurol Scand 2006;113:301–06
In this issue
Advertisement
CT Angiography Clot Burden Score and Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute Middle Cerebral Artery Infarct
I.Y.L. Tan, A.M. Demchuk, J. Hopyan, L. Zhang, D. Gladstone, K. Wong, M. Martin, S.P. Symons, A.J. Fox, R.I. Aviv
American Journal of Neuroradiology Mar 2009, 30 (3) 525-531; DOI: 10.3174/ajnr.A1408
CT Angiography Clot Burden Score and Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute Middle Cerebral Artery Infarct
I.Y.L. Tan, A.M. Demchuk, J. Hopyan, L. Zhang, D. Gladstone, K. Wong, M. Martin, S.P. Symons, A.J. Fox, R.I. Aviv
American Journal of Neuroradiology Mar 2009, 30 (3) 525-531; DOI: 10.3174/ajnr.A1408
Jump to section
Related Articles
- No related articles found.
Cited By...
- Predictors of futile recanalization in patients undergoing endovascular treatment in the DIRECT-MT trial
- Radiology-Pathology Correlations of Intracranial Clots: Current Theories, Clinical Applications, and Future Directions
- Hypoperfusion Intensity Ratio Correlates with CTA Collateral Status in Large-Vessel Occlusion Acute Ischemic Stroke
- Absent Cortical Venous Filling Is Associated with Aggravated Brain Edema in Acute Ischemic Stroke
- Early recanalization in large-vessel occlusion stroke patients transferred for endovascular treatment
- Small thrombus size, thrombus composition, and poor collaterals predict pre-interventional thrombus migration
- Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry
- Systematic review protocol to assess artificial intelligence diagnostic accuracy performance in detecting acute ischaemic stroke and large-vessel occlusions on CT and MR medical imaging
- Prediction of Clinical Outcome in Patients with Large-Vessel Acute Ischemic Stroke: Performance of Machine Learning versus SPAN-100
- Distal Vessel Imaging via Intra-arterial Flat Panel Detector CTA during Mechanical Thrombectomy
- Association of White Matter Lesions and Outcome After Endovascular Stroke Treatment
- Clot Burden Score and Collateral Status and Their Impact on Functional Outcome in Acute Ischemic Stroke
- Endovascular treatment in older adults with acute ischemic stroke in the MR CLEAN Registry
- Artificial intelligence to diagnose ischemic stroke and identify large vessel occlusions: a systematic review
- Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN Registry
- Greater infarct growth limiting effect of mechanical thrombectomy in stroke patients with poor collaterals
- Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry
- Clot Burden Score and Early Ischemia Predict Intracranial Hemorrhage following Endovascular Therapy
- Inter- and intraobserver reliability for angiographic leptomeningeal collateral flow assessment by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale
- Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017
- Value of Contrast-Enhanced MRA versus Time-of-Flight MRA in Acute Ischemic Stroke MRI
- Republished: Natures Wastebasket: The Role of the External Carotid Artery in Acute Stroke
- Similar Outcomes for Contact Aspiration and Stent Retriever Use According to the Admission Clot Burden Score in ASTER
- Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke
- Impact of time to endovascular reperfusion on outcome differs according to the involvement of the proximal MCA territory
- Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry)
- Erythrocyte Fraction Within Retrieved Thrombi Contributes to Thrombolytic Response in Acute Ischemic Stroke
- Vulnerability to Infarction During Cerebral Ischemia in Migraine Sufferers
- Associations Between Collateral Status and Thrombus Characteristics and Their Impact in Anterior Circulation Stroke
- Opercular Index Score: a CT angiography-based predictor of capillary robustness and neurological outcomes in the endovascular management of acute ischemic stroke
- Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy: analysis of the SWIFT PRIME trial
- Tissue-Selective Salvage of the White Matter by Successful Endovascular Stroke Therapy
- CT angiography-based collateral flow and time to reperfusion are strong predictors of outcome in endovascular treatment of patients with stroke
- Prediction of Clinical Outcome After Acute Ischemic Stroke: The Value of Repeated Noncontrast Computed Tomography, Computed Tomographic Angiography, and Computed Tomographic Perfusion
- The Impact of Conscious Sedation versus General Anesthesia for Stroke Thrombectomy on the Predictive Value of Collateral Status: A Post Hoc Analysis of the SIESTA Trial
- Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke: mapping of intra-arterial treatment effect
- Evaluation of Collaterals and Clot Burden Using Time-Resolved C-Arm Conebeam CT Angiography in the Angiography Suite: A Feasibility Study
- Towards personalised intra-arterial treatment of patients with acute ischaemic stroke: a study protocol for development and validation of a clinical decision aid
- Acute Ischemic Stroke Therapy Overview
- Natures Wastebasket: The Role of the External Carotid Artery in Acute Stroke
- Endovascular therapy for acute ischaemic stroke: the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) randomised, controlled trial
- Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke
- Uric Acid Therapy Prevents Early Ischemic Stroke Progression: A Tertiary Analysis of the URICO-ICTUS Trial (Efficacy Study of Combined Treatment With Uric Acid and r-tPA in Acute Ischemic Stroke)
- Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Lower NIHSS Scores: Recanalization Rates, Periprocedural Complications, and Clinical Outcome
- Comparison of CTA- and DSA-Based Collateral Flow Assessment in Patients with Anterior Circulation Stroke
- Role of atherosclerosis, clot extent, and penumbra volume in headache during ischemic stroke
- Performance of CT ASPECTS and Collateral Score in Risk Stratification: Can Target Perfusion Profiles Be Predicted without Perfusion Imaging?
- Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts
- Intravenous thrombolysis of large vessel occlusions is associated with higher hospital costs than small vessel strokes: a rationale for developing stroke severity-based financial models
- Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke
- Association Between CT Angiogram Collaterals and CT Perfusion in the Interventional Management of Stroke III Trial
- Comparing Vessel Imaging: Noncontrast Computed Tomography/Computed Tomographic Angiography Should Be the New Minimum Standard in Acute Disabling Stroke
- Effect of Collaterals on Clinical Presentation, Baseline Imaging, Complications, and Outcome in Acute Stroke
- Combined Multimodal Computed Tomography Score Correlates With Futile Recanalization After Thrombectomy in Patients With Acute Stroke
- Performance and Predictive Value of a User-Independent Platform for CT Perfusion Analysis: Threshold-Derived Automated Systems Outperform Examiner-Driven Approaches in Outcome Prediction of Acute Ischemic Stroke
- Uric Acid Therapy Improves Clinical Outcome in Women With Acute Ischemic Stroke
- Predictors of Reperfusion in Patients with Acute Ischemic Stroke
- 4D-CTA in Neurovascular Disease: A Review
- Contribution and Additional Impact of Imaging to the SPAN-100 Score
- Prediction of Infarction and Reperfusion in Stroke by Flow- and Volume-Weighted Collateral Signal in MR Angiography
- Assessment of Intracranial Collaterals on CT Angiography in Anterior Circulation Acute Ischemic Stroke
- Collateral Score Complements Clot Location in Predicting the Outcome of Intravenous Thrombolysis
- Length of Occlusion Predicts Recanalization and Outcome After Intravenous Thrombolysis in Middle Cerebral Artery Stroke
- CTA Collateral Status and Response to Recanalization in Patients with Acute Ischemic Stroke
- Thrombus length estimation in acute ischemic stroke: a potential role for delayed contrast enhanced CT
- The Impact of Arterial Collateralization on Outcome after Intra-Arterial Therapy for Acute Ischemic Stroke
- Toward Patient-Tailored Perfusion Thresholds for Prediction of Stroke Outcome
- Optimizing Prediction Scores for Poor Outcome After Intra-Arterial Therapy in Anterior Circulation Acute Ischemic Stroke
- 4D CT Angiography More Closely Defines Intracranial Thrombus Burden Than Single-Phase CT Angiography
- Timing-Invariant Imaging of Collateral Vessels in Acute Ischemic Stroke
- Clot Burden Score on Admission T2*-MRI Predicts Recanalization in Acute Stroke
- Comparison of Short-term Outcomes of Thrombolysis for In-Hospital Stroke and Out-of-Hospital Stroke in United States
- Computed Tomography Angiography in Hyperacute Ischemic Stroke: Prognostic Implications and Role in Decision-Making
This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.
More in this TOC Section
Similar Articles
Advertisement