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Research ArticleInterventional

Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke

A.M.M. Boers, R. Sales Barros, I.G.H. Jansen, O.A. Berkhemer, L.F.M. Beenen, B.K. Menon, D.W.J. Dippel, A. van der Lugt, W.H. van Zwam, Y.B.W.E.M. Roos, R.J. van Oostenbrugge, C.H. Slump, C.B.L.M. Majoie and H.A. Marquering on behalf of the MR CLEAN investigators
American Journal of Neuroradiology June 2018, 39 (6) 1074-1082; DOI: https://doi.org/10.3174/ajnr.A5623
A.M.M. Boers
aFrom the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.)
bRadiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
dDepartment of Robotics and Mechatronics (A.M.M.B., C.H.S.)
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  • ORCID record for A.M.M. Boers
R. Sales Barros
aFrom the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.)
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I.G.H. Jansen
aFrom the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.)
bRadiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
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O.A. Berkhemer
bRadiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
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L.F.M. Beenen
bRadiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
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B.K. Menon
fDepartment of Clinical Neurosciences (B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
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D.W.J. Dippel
gDepartments of Neurology (D.W.J.D.)
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A. van der Lugt
hRadiology (A.v.d.L.), Erasmus MC, Rotterdam, the Netherlands
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W.H. van Zwam
iDepartment of Radiology (W.H.v.Z.), Maastricht UMC, Maastricht, the Netherlands
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Y.B.W.E.M. Roos
cNeurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands
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R.J. van Oostenbrugge
jDepartment of Neurology (R.J.v.O.), Maastricht UMC and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
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C.H. Slump
dDepartment of Robotics and Mechatronics (A.M.M.B., C.H.S.)
eMIRA Institute for Biomedical Engineering and Technical Medicine (C.H.S.), University of Twente, Enschede, the Netherlands
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C.B.L.M. Majoie
bRadiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
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H.A. Marquering
aFrom the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.)
bRadiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
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Abstract

BACKGROUND AND PURPOSE: Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship.

MATERIALS AND METHODS: From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected. The quantitative collateral score was calculated as the ratio of the vascular appearance of both hemispheres and was compared with the visual collateral score. Primary outcomes were 90-day mRS score and follow-up infarct volume. The relation with outcome and the association with treatment effect were estimated. The influence of the CTA acquisition phase on the relation of collateral scores with outcome was determined.

RESULTS: A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score (ρ = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95% CI, .77–.86) and follow-up infarct volume (exponent β = 0.88; P < .001) per 10% increase. The quantitative collateral score showed areas under the curve of 0.71 and 0.69 for predicting functional independence (mRS 0–2) and follow-up infarct volume of >90 mL, respectively. We found significant interaction of the quantitative collateral score with the endovascular therapy effect in unadjusted analysis on the full ordinal mRS scale (P = .048) and on functional independence (P = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: P = .004; follow-up infarct volume: P < .001) in adjusted analysis.

CONCLUSIONS: Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.

ABBREVIATIONS:

EVT
endovascular therapy
FIV
follow-up infarct volume
ICA-T
ICA carotid bifurcation
IQR
interquartile range
MR CLEAN
Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands
qCS
quantitative collateral score
vCS
visual collateral score
  • © 2018 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 39 (6)
American Journal of Neuroradiology
Vol. 39, Issue 6
1 Jun 2018
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Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke
A.M.M. Boers, R. Sales Barros, I.G.H. Jansen, O.A. Berkhemer, L.F.M. Beenen, B.K. Menon, D.W.J. Dippel, A. van der Lugt, W.H. van Zwam, Y.B.W.E.M. Roos, R.J. van Oostenbrugge, C.H. Slump, C.B.L.M. Majoie, H.A. Marquering
American Journal of Neuroradiology Jun 2018, 39 (6) 1074-1082; DOI: 10.3174/ajnr.A5623

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Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke
A.M.M. Boers, R. Sales Barros, I.G.H. Jansen, O.A. Berkhemer, L.F.M. Beenen, B.K. Menon, D.W.J. Dippel, A. van der Lugt, W.H. van Zwam, Y.B.W.E.M. Roos, R.J. van Oostenbrugge, C.H. Slump, C.B.L.M. Majoie, H.A. Marquering
American Journal of Neuroradiology Jun 2018, 39 (6) 1074-1082; DOI: 10.3174/ajnr.A5623
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