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Research ArticleBrainE
Open Access

Malignant CTA Collateral Profile Is Highly Specific for Large Admission DWI Infarct Core and Poor Outcome in Acute Stroke

L.C.S. Souza, A.J. Yoo, Z.A. Chaudhry, S. Payabvash, A. Kemmling, P.W. Schaefer, J.A. Hirsch, K.L. Furie, R.G. González, R.G. Nogueira and M.H. Lev
American Journal of Neuroradiology August 2012, 33 (7) 1331-1336; DOI: https://doi.org/10.3174/ajnr.A2985
L.C.S. Souza
aFrom the Departments of Radiology (L.C.S.S., A.J.Y., Z.A.C., S.P., A.K., P.W.S., J.A.H., R.G.G., M.H.L.)
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A.J. Yoo
aFrom the Departments of Radiology (L.C.S.S., A.J.Y., Z.A.C., S.P., A.K., P.W.S., J.A.H., R.G.G., M.H.L.)
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Z.A. Chaudhry
aFrom the Departments of Radiology (L.C.S.S., A.J.Y., Z.A.C., S.P., A.K., P.W.S., J.A.H., R.G.G., M.H.L.)
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S. Payabvash
aFrom the Departments of Radiology (L.C.S.S., A.J.Y., Z.A.C., S.P., A.K., P.W.S., J.A.H., R.G.G., M.H.L.)
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A. Kemmling
aFrom the Departments of Radiology (L.C.S.S., A.J.Y., Z.A.C., S.P., A.K., P.W.S., J.A.H., R.G.G., M.H.L.)
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P.W. Schaefer
aFrom the Departments of Radiology (L.C.S.S., A.J.Y., Z.A.C., S.P., A.K., P.W.S., J.A.H., R.G.G., M.H.L.)
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J.A. Hirsch
aFrom the Departments of Radiology (L.C.S.S., A.J.Y., Z.A.C., S.P., A.K., P.W.S., J.A.H., R.G.G., M.H.L.)
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K.L. Furie
bNeurology (K.L.F., R.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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R.G. González
aFrom the Departments of Radiology (L.C.S.S., A.J.Y., Z.A.C., S.P., A.K., P.W.S., J.A.H., R.G.G., M.H.L.)
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R.G. Nogueira
bNeurology (K.L.F., R.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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M.H. Lev
aFrom the Departments of Radiology (L.C.S.S., A.J.Y., Z.A.C., S.P., A.K., P.W.S., J.A.H., R.G.G., M.H.L.)
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  • Fig 1.
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    Fig 1.

    CS system: 0 = absent collaterals >50% of an M2 territory; 1 = diminished collaterals >50% M2 territory; 2 = diminished collaterals <50% M2 territory; 3 = collaterals equal to contralateral side; 4 = increased collaterals.

  • Fig 2.
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    Fig 2.

    There is progressive decrease in admission (A) DWI lesion volumes (P < .001) and (B) NIHSS (P < .001) as CS increases. Error bars represent 95% confidence intervals.

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    Fig 3.

    ROC curves for CS versus DWI volumes (A) >100 mL (AUC = 0.84, P < .001) and (B) >70 mL (AUC = 0.78, P < .001). Tables display test characteristics for various scores, including optimal operating points (*), and positive (PPV) and negative predictive values (NPV).

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    Fig 4.

    Scatterplot of DWI volumes versus CSs. Most CS = 0 patients have lesion volumes >70–100 mL (horizontal lines). There is great overlap between the other CS categories.

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    Fig 5.

    Distribution of mRS scores between patients with CS = 0 versus >0.

Tables

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    Table 1:

    Univariate analysis for dichotomized collateral score

    Collateral = 0Collateral > 0P value
    Number of patients22175
    Age71 ± 1566 ± 170.25
    Sex (female)41%36%0.88
    Side of stroke (left side)59%47%0.44
    Blood glucose (mg/dl)149 ± 63140 ± 500.56
    Systolic blood pressure (mm Hg)153 ± 125150 ± 330.73
    NIHSS score21 (17–26)15 (11–18)<0.001
    DWI lesion volume (ml)165.8 ± 1932.7 ± 2.7<0.001
    3-month mRS5 (3–6)3 (1–5)0.022
    Dependent or deceased (mRS >2)95.5%64.0%0.003
    Treatment (IV and/or IA)63.6%67.2%0.74
    • Note:—Results are expressed in mean ± SD, median (interquartile range), or percentages.

    • View popup
    Table 2:

    Outcome by treatment and by collateral score

    Collateral = 0Collateral > 0P value
    No treatment (# patients)845
    Good outcome (mRS ≤ 2)0%35.6%0.044
    Poor outcome (mRS > 2)100%64.4%
    IV treatment only (# patients)1330
    Good outcome (mRS ≤ 2)7.7%50.0%0.008
    Poor outcome (mRS > 2)92.3%50.0%
    IA treatment ± IV (# patients)175
    Good outcome (mRS ≤ 2)0%30.7%0.507
    Poor outcome (mRS > 2)100%69.3%
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American Journal of Neuroradiology: 33 (7)
American Journal of Neuroradiology
Vol. 33, Issue 7
1 Aug 2012
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Malignant CTA Collateral Profile Is Highly Specific for Large Admission DWI Infarct Core and Poor Outcome in Acute Stroke
L.C.S. Souza, A.J. Yoo, Z.A. Chaudhry, S. Payabvash, A. Kemmling, P.W. Schaefer, J.A. Hirsch, K.L. Furie, R.G. González, R.G. Nogueira, M.H. Lev
American Journal of Neuroradiology Aug 2012, 33 (7) 1331-1336; DOI: 10.3174/ajnr.A2985

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Malignant CTA Collateral Profile Is Highly Specific for Large Admission DWI Infarct Core and Poor Outcome in Acute Stroke
L.C.S. Souza, A.J. Yoo, Z.A. Chaudhry, S. Payabvash, A. Kemmling, P.W. Schaefer, J.A. Hirsch, K.L. Furie, R.G. González, R.G. Nogueira, M.H. Lev
American Journal of Neuroradiology Aug 2012, 33 (7) 1331-1336; DOI: 10.3174/ajnr.A2985
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