Abstract：
BACKGROUND: Collaterals are a strong determinant of clinical outcome in acute ischemic stroke (AIS) patients undergoing Endovascular Treatment (EVT). Careggi Collateral Score (CCS) is an angiographic score that demonstrated to be superior to the widely suggested ASITN/SIR score. Multi-phase CT-Angiography (mCTA) could be alternatively adopted for collateral assessment. We investigated whether mCTA had an equivalent predictive performance for functional outcome compared to CCS.
METHODS: Consecutive AIS patients undergoing EVT for large vessel occlusion within 24 h from onset were analyzed. Receiver operating characteristic curves and multivariable logistic regression were investigated to evaluate the predictive performance of mCTA collateral score (range 0-5) and CCS (range 0-4) for good functional outcome (three-months modified Rankin Scale 0-2).
RESULTS: We included 201 subjects (59.7% females, mean age 75), of whom 96 (47.7%) had good outcome at three-months. Both CCS (OR = 14.4, 95% CI = 6.3-33.8) and mCTA (OR = 23.8, 95% CI = 10.1-56.4) collateral scores were independent predictors of outcome. The AUC of CCS was 0.80 (95% CI 0.73-0.86) and the best cut-off was ≥ 3 (87% sensitivity, 71% specificity), while the AUC of mCTA collateral score was 0.84 (95% CI 0.78-0.90) with an optimal cut-off of ≥ 4 (85% sensitivity, 87% specificity). Patients with good mCTA collaterals experienced smaller (16.6 vs. 63.7 mL, p < 0.001) infarct lesion as compared to those with mCTA poor collaterals.
CONCLUSIONS: mCTA discriminative ability for three-months 0-2 mRS was found to be comparable to CCS. mCTA appears a valid, non-invasive imaging modality for evaluating collaterals of AIS patients potentially eligible for EVT.
METHODS: Consecutive AIS patients undergoing EVT for large vessel occlusion within 24 h from onset were analyzed. Receiver operating characteristic curves and multivariable logistic regression were investigated to evaluate the predictive performance of mCTA collateral score (range 0-5) and CCS (range 0-4) for good functional outcome (three-months modified Rankin Scale 0-2).
RESULTS: We included 201 subjects (59.7% females, mean age 75), of whom 96 (47.7%) had good outcome at three-months. Both CCS (OR = 14.4, 95% CI = 6.3-33.8) and mCTA (OR = 23.8, 95% CI = 10.1-56.4) collateral scores were independent predictors of outcome. The AUC of CCS was 0.80 (95% CI 0.73-0.86) and the best cut-off was ≥ 3 (87% sensitivity, 71% specificity), while the AUC of mCTA collateral score was 0.84 (95% CI 0.78-0.90) with an optimal cut-off of ≥ 4 (85% sensitivity, 87% specificity). Patients with good mCTA collaterals experienced smaller (16.6 vs. 63.7 mL, p < 0.001) infarct lesion as compared to those with mCTA poor collaterals.
CONCLUSIONS: mCTA discriminative ability for three-months 0-2 mRS was found to be comparable to CCS. mCTA appears a valid, non-invasive imaging modality for evaluating collaterals of AIS patients potentially eligible for EVT.
摘要：
背景：在接受血管内治疗（EVT）的急性缺血性卒中（AIS）患者中，侧支是临床结局的重要决定因素。CareggiCollateral评分（CCS）是一种血管造影评分，被证明优于广泛建议的ASITN/SIR评分。多期CT血管造影（mCTA）可用于侧支评估。我们调查了mCTA与CCS相比对功能结局的预测性能是否相等。
方法：对发病24h内接受EVT大血管闭塞的连续AIS患者进行分析。研究了受试者工作特征曲线和多变量逻辑回归，以评估mCTA侧支评分（范围0-5）和CCS（范围0-4）对良好功能结局（三个月改良的Rankin量表0-2）的预测性能。
结果：我们包括201名受试者（59.7％的女性，平均年龄75)，其中96人(47.7%)在三个月时预后良好。CCS（OR=14.4，95％CI=6.3-33.8）和mCTA（OR=23.8，95％CI=10.1-56.4）侧支评分均为结局的独立预测因子。CCS的AUC为0.80（95％CI0.73-0.86），最佳截止值为≥3（87％灵敏度，71%的特异性)，而mCTA侧支评分的AUC为0.84(95%CI0.78-0.90)，最佳临界值≥4(85%敏感性，87%的特异性)。具有良好mCTA侧支的患者经历较小（16.6vs.63.7mL,p<0.001）与mCTA欠脉患者相比，梗死灶。
结论：发现3个月0-2mRS的mCTA判别能力与CCS相当。mCTA似乎是有效的，非侵入性成像模式，用于评估可能符合EVT的AIS患者的侧支。
方法：对发病24h内接受EVT大血管闭塞的连续AIS患者进行分析。研究了受试者工作特征曲线和多变量逻辑回归，以评估mCTA侧支评分（范围0-5）和CCS（范围0-4）对良好功能结局（三个月改良的Rankin量表0-2）的预测性能。
结果：我们包括201名受试者（59.7％的女性，平均年龄75)，其中96人(47.7%)在三个月时预后良好。CCS（OR=14.4，95％CI=6.3-33.8）和mCTA（OR=23.8，95％CI=10.1-56.4）侧支评分均为结局的独立预测因子。CCS的AUC为0.80（95％CI0.73-0.86），最佳截止值为≥3（87％灵敏度，71%的特异性)，而mCTA侧支评分的AUC为0.84(95%CI0.78-0.90)，最佳临界值≥4(85%敏感性，87%的特异性)。具有良好mCTA侧支的患者经历较小（16.6vs.63.7mL,p<0.001）与mCTA欠脉患者相比，梗死灶。
结论：发现3个月0-2mRS的mCTA判别能力与CCS相当。mCTA似乎是有效的，非侵入性成像模式，用于评估可能符合EVT的AIS患者的侧支。
