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Neuroradiology

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01-11-2017 | Diagnostic Neuroradiology

Time-resolved CT assessment of collaterals as imaging biomarkers to predict clinical outcomes in acute ischemic stroke

Authors: Elizabeth Tong, Jim Patrie, Sara Tong, Avery Evans, Patrik Michel, Ashraf Eskandari, Max Wintermark

Published in: Neuroradiology | Issue 11/2017

Abstract

Purpose

Collateral circulation plays a pivotal role in the pathophysiology of acute ischemic stroke and is increasingly recognized as a promising biomarker for predicting the clinical outcome. However, there is no single established grading system. We designed a novel machine-learning software that allows non-invasive, objective, and quantitative assessment of collaterals according to their vascular territories. Our goal is to investigate the prognostic and predictive value of this collateral score for the prediction of acute stroke outcome.

Methods

This is a retrospective study of 135 patients with anterior circulation stroke treated with IV TPA. An equation using this collateral score (adjusting for age, baseline NIHSS, and recanalization) was derived to predict the clinical outcome (90-day mRS). The primary analyses focused on determining the prognostic value of our newly developed collateral scores. Secondary analyses examined the interrelationships between the collateral score and other variables.

Results

The collateral score emerged as a statistically significant prognostic biomarker for good clinical outcome (p < 0.033) among recanalized patients, but not among non-recanalized patients (p < 0.497). Our results also showed that collateral score was a predictive biomarker (p < 0.044). These results suggest that (1) patients with good collateral score derive more benefit from successful recanalization than patients with poor collateral score and (2) collateral status is inconsequential if recanalization is not achieved.

Conclusion

Our data results reinforce the importance of careful patient selection for recanalization therapy to avoid futile recanalization. The paucity of collaterals predicts poor clinical outcome despite recanalization. On the other hand, robust collaterals warrant consideration for recanalization therapy given the better odds of good clinical outcome.

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Title: Time-resolved CT assessment of collaterals as imaging biomarkers to predict clinical outcomes in acute ischemic stroke
Authors: Elizabeth Tong
Jim Patrie
Sara Tong
Avery Evans
Patrik Michel
Ashraf Eskandari
Max Wintermark
Publication date: 01-11-2017
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 11/2017
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-017-1914-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Time-resolved CT assessment of collaterals as imaging biomarkers to predict clinical outcomes in acute ischemic stroke

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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