Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window?

Neurointervention

Ho Geol Woo¹  Seunguk Jung²  Moon-Ku Han³  Hee-Joon Bae³  Beom Joon Kim³  Sang-Hoon Cha⁴  Byung Se Choi⁵  Yun Jung Bae⁵  Leonard Sunwoo⁵  Jae Hyoung Kim⁵  Cheolkyu Jung⁵ 

[1] Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea;Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Korea;Department of Neurology, Seoul National University Bundang Hospital, Korea;Department of Radiology, Chungbuk National University College of Medicine, Cheongju, Korea;Department of Radiology, Seoul National University Bundang Hospital, Korea;

关键词: stroke;    computed tomography angiography;    thrombectomy;   

DOI  :  10.5469/neuroint.2019.00080

来源: DOAJ

【 摘 要 】

Purpose Although endovascular treatment is currently thought to only be suitable for patients who have pial arterial filling scores >3 as determined by multiphase computed tomography angiography (mpCTA), a cut-off score of 3 was determined by a study, including patients within 12 hours after symptom onset. We aimed to investigate whether a cut-off score of 3 for endovascular treatment within 6 hours of symptom onset is an appropriate predictor of good functional outcome at 3 months. Materials and Methods From April 2015 to January 2016, acute ischemic stroke patients treated with mechanical thrombectomy within 6 hours of symptom onset were enrolled into this study. Pial arterial filling scores were semi-quantitatively assessed using mpCTA, and clinical and radiological parameters were compared between patients with favorable and unfavorable outcomes. Multivariate logistic regression analysis was then performed to investigate the independent association between clinical outcome and pial collateral score, with the predictive power of the latter assessed using C-statistics. Results Of the 38 patients enrolled, 20 (52.6%) had a favorable outcome and 18 had an unfavorable outcome, with the latter group showing a lower mean pial arterial filling score (3.6±0.8 vs. 2.4±1.2, P=0.002). After adjusting for variables with a P-value of <0.1 in univariate analysis (i.e., age and National Institutes of Health Stroke Scale score at admission), pial arterial filling scores higher than a cut-off of 2 were found to be independently associated with favorable clinical outcomes (P=0.012). C-statistic analysis confirmed that our model had the highest prediction power when pial arterial filling scores were dichotomized at >2 vs. ≤2. Conclusion A pial arterial filling cut-off score of 2 as determined by mpCTA appears to be more suitable for predicting clinical outcomes following endovascular treatment within 6 hours of symptom onset than the cut-off of 3 that had been previously suggested.

【 授权许可】

Unknown