The Cortical Vein Opacification Score (COVES) Is Independently Associated with DSA ASITN Collateral Score

Dhairya A. Lakhani; Aneri B. Balar; Subtain Ali; Musharaf Khan; Hamza Salim; Manisha Koneru; Sijin Wen; Richard Wang; Janet Mei; Argye E. Hillis; Jeremy J. Heit; Greg W. Albers; Adam A. Dmytriw; Tobias D. Faizy; Max Wintermark; Kambiz Nael; Ansaar T. Rai; Vivek S. Yedavalli

doi:10.3174/ajnr.A8601

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Graphical Abstract

Abstract

BACKGROUND AND PURPOSE: Pretreatment CTA-based Cortical Vein Opacification Score (COVES) has been shown to predict good functional outcomes at 90 days in patients with acute ischemic stroke secondary to large vessel occlusion (AIS-LVO). This is thought to be related to its ability to measure collateral status (CS). However, its association with the reference standard test, the DSA-based American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score, has yet to be established. Therefore, this study assesses the relationship between COVES and ASITN CS.

MATERIALS AND METHODS: In this prospectively collected, retrospectively reviewed analysis, patients with anterior circulation LVO from September 1, 2017, to October 1, 2023, were included. The COVES grading, which ranges from 0 to 6, was independently assessed by 2 board-certified neuroradiologists. The ASITN CS was independently assessed by a board-certified neuroradiologist and the performing neurointerventionalist. Any discrepancies were resolved through consensus review. Spearman rank correlation, univariable logistic regression, multivariable logistic regression, and receiver operating characteristic curve analysis were performed. A P value of ≤ .05 was considered significant.

RESULTS: In total, 311 consecutive patients (median, IQR = 68 years [59–78 years]; 55.9% women) met our inclusion criteria. There was significant positive correlation between COVES and ASITN CS (ρ = 0.41, P < .001), and higher COVES was significantly and independently associated with good ASITN CS (unadjusted-OR = 1.74, P < .001) and adjusted-OR = 1.73, P < .001). Receiver operating characteristic curve analysis showed area under the curve of 0.71, P < .001).

CONCLUSIONS: By demonstrating the independent association of COVES with the reference standard test for collateral status assessment, the ASITN CS, we further validate the role of COVES in estimating collateral status.