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Research ArticleADULT BRAIN
Open Access

Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume

I.R. van den Wijngaard, G. Holswilder, M.J.H. Wermer, J. Boiten, A. Algra, D.W.J. Dippel, J.W. Dankbaar, B.K. Velthuis, A.M.M. Boers, C.B.L.M. Majoie and M.A.A. van Walderveen
American Journal of Neuroradiology July 2016, 37 (7) 1231-1236; DOI: https://doi.org/10.3174/ajnr.A4746
I.R. van den Wijngaard
aFrom the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.)
dDepartment of Neurology (I.R.v.d.W., J.B.), Medical Center Haaglanden, the Hague, the Netherlands
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  • ORCID record for I.R. van den Wijngaard
G. Holswilder
aFrom the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.)
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M.J.H. Wermer
bNeurology (M.J.H.W.)
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J. Boiten
dDepartment of Neurology (I.R.v.d.W., J.B.), Medical Center Haaglanden, the Hague, the Netherlands
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A. Algra
cClinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, the Netherlands
eDepartment of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus
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D.W.J. Dippel
gDepartment of Neurology (D.W.J.D.), Erasmus University Medical Center, Rotterdam, the Netherlands
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J.W. Dankbaar
fDepartment of Radiology (J.W.D., B.K.V.), University Medical Center Utrecht, Utrecht, the Netherlands
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B.K. Velthuis
fDepartment of Radiology (J.W.D., B.K.V.), University Medical Center Utrecht, Utrecht, the Netherlands
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A.M.M. Boers
hDepartments of Radiology (A.M.M.B., C.B.L.M.M.)
iBiomedical Engineering and Physics (A.M.M.B.), Academic Medical Center, Amsterdam, the Netherlands.
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C.B.L.M. Majoie
hDepartments of Radiology (A.M.M.B., C.B.L.M.M.)
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M.A.A. van Walderveen
aFrom the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.)
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    Fig 1.

    Patterns of contralateral and ipsilateral vessel filling for all patients and for 4 different subgroups. A, Ipsilateral and contralateral vessel filling of all patients (n = 61). Time in seconds after contrast arrival in the ICA was calculated for each volume and averaged for multiple patients for each different time point in seconds. Green dots represent mean filling with time after contrast arrival for the ipsilateral (ie, affected) hemisphere. Blue dots represent mean filling with time after contrast arrival in the ICA for the unaffected contralateral hemisphere. Error bars represent 1 standard error of the mean (1 standard error). Dotted vertical lines indicate the optimal assessment interval, which is defined by the presence of the 3 highest average collateral scores in both the affected and unaffected hemispheres. B, Patients with poor collateral filling of <50% of the ischemic territory and slow filling, defined as ipsilateral filling reaching optimal filling >4.5 seconds later than contralateral optimal vessel filling (n = 5). C, Patients with poor collateral filling of <50% of the ischemic territory but with fast filling within 4.5 seconds after contralateral optimal vessel filling (n = 12). D, Patients with good collateral filling of >50% and slow filling (n = 22). E, Patients with good collateral filling of >50% and fast filling (n = 22).

Tables

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  • Poor radiologic outcome at follow-up (infarct volume ≥70 mL) in relation to CSs (N = 61)

    Poor Outcome/Characteristic Present (n/N) (%)Poor Outcome/Characteristic Absent (n/N) (%)Risk Ratio (95% CI)
    Single-phase CTA
        Poor extent of collateral fillinga25/42 (60%)8/19 (42%)1.4 (0.8–2.5)
    Dynamic CTA, extent of filling
        CS 0–1–––
        CS 25/5 (100%)7/19 (37%)b2.7 (1.5–4.9)
        CS 39/12 (75%)7/19 (37%)b2.0 (1.0–4.0)
        CS 48/13 (62%)7/19 (37%)b1.7 (0.8–3.5)
        CS 54/12 (33%)7/19 (37%)b0.9 (0.4–2.4)
    Dynamic CTA
        Poor extent of collateral fillinga14/17 (82%)19/44 (43%)1.9 (1.3–2.9)
    Dynamic CTA, extent and timing of filling
        Poor collaterals and slow filling4/5 (80%)9/22 (41%)c2.0 (1.0–3.8)
        Poor collaterals and fast filling23/30 (77%)9/22 (41%)c1.9 (1.1–3.2)
        Good collaterals and slow filling14/26 (54%)9/22 (41%)1.3 (0.7–2.4)
    • ↵a Poor extent of collateral filling was defined as collateral filling in ≤50% of the occluded MCA territory in the affected hemisphere.

    • ↵b CS 6 (maximum collateral score) was taken as a reference.

    • ↵c Group with good and fast collateral filling was taken as a reference.

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American Journal of Neuroradiology: 37 (7)
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I.R. van den Wijngaard, G. Holswilder, M.J.H. Wermer, J. Boiten, A. Algra, D.W.J. Dippel, J.W. Dankbaar, B.K. Velthuis, A.M.M. Boers, C.B.L.M. Majoie, M.A.A. van Walderveen
Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume
American Journal of Neuroradiology Jul 2016, 37 (7) 1231-1236; DOI: 10.3174/ajnr.A4746

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Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume
I.R. van den Wijngaard, G. Holswilder, M.J.H. Wermer, J. Boiten, A. Algra, D.W.J. Dippel, J.W. Dankbaar, B.K. Velthuis, A.M.M. Boers, C.B.L.M. Majoie, M.A.A. van Walderveen
American Journal of Neuroradiology Jul 2016, 37 (7) 1231-1236; DOI: 10.3174/ajnr.A4746
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