Assessment of Collateral Circulation Using Perfusion CT in Middle Cerebral Artery Thrombectomy-Treated Patients

J Stroke Cerebrovasc Dis. 2020 Jul;29(7):104805. doi: 10.1016/j.jstrokecerebrovasdis.2020.104805. Epub 2020 Apr 23.

Abstract

Introduction: The prognostic value of leptomeningeal collateral circulation in thrombectomy-treated patients remains unclear. We evaluated the construct validity of assessing leptomeningeal collateral circulation using a new regional perfusion CT source image-based approach, the Perfusion Acquisition for THrombectomy Scale (PATHS). We also compared the prognostic value of PATHS with a further 6 scales based on various techniques: CT-angiography, perfusion CT, and digital subtraction angiography. Additionally, we studied the relationship between the scores for the different scales.

Patients and methods: We performed a retrospective study of consecutive patients with stroke and M1/terminal carotid occlusion treated with thrombectomy in our center. Leptomeningeal collateral circulation was prospectively evaluated using 7 scales: Tan and Miteff (CT Angiography); Calleja, Cao, American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology, and PATHS (perfusion); and Christoforidis (Digital Subtraction Angiography). Correlations were studied using the Spearman method.

Results: The study population comprised 108 patients. All scales predicted the modified Rankin Scale at 3 months (P ≤ .02) and all but 1 (Christoforidis) correlated with 24-hour brain infarct volume (P ≤ .02). These correlations were higher with PATHS (rho = -0.47, P < .001 for 3-month modified Rankin Scale; rho = -0.35, P < .001 for follow-up infarct volume). The multivariate analysis showed PATHS to be an independent predictor of modified Rankin Scale at 3 months less than equal to 2. A crosscorrelation analysis revealed a better correlation between scales that used the same techniques.

Conclusions: PATHS can be used to assess leptomeningeal collateral circulation. PATHS had better prognostic value than other scales; therefore, it might be considered for assessment of leptomeningeal collateral circulation in candidates for thrombectomy. The moderate correlation between scales suggests that scores are not interchangeable.

Keywords: Ischemic stroke; collateral circulation; endovascular treatment; perfusion CT; stroke imaging; thrombectomy.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cerebral Angiography
  • Cerebrovascular Circulation*
  • Collateral Circulation*
  • Computed Tomography Angiography
  • Disability Evaluation
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / diagnostic imaging
  • Infarction, Middle Cerebral Artery / mortality
  • Infarction, Middle Cerebral Artery / physiopathology
  • Infarction, Middle Cerebral Artery / therapy*
  • Male
  • Middle Aged
  • Middle Cerebral Artery / diagnostic imaging*
  • Middle Cerebral Artery / physiopathology
  • Multidetector Computed Tomography*
  • Observer Variation
  • Perfusion Imaging / methods*
  • Predictive Value of Tests
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Thrombectomy* / adverse effects
  • Thrombectomy* / mortality
  • Time Factors
  • Treatment Outcome