CT Perfusion collateral index in assessment of collaterals in acute ischemic stroke with delayed presentation: Comparison to single phase CTA - 04/12/21

Doi : 10.1016/j.neurad.2021.11.002

Kambiz Nael ^a,^b,^⁎ , Yu Sakai ^b, Jonathan Larson ^b, Jared Goldstein ^b, Jacob Deutsch ^b, Ahmed J. Awad ^c, Puneet Pawha ^b, Amit Aggarwal ^b, Johanna Fifi ^c, Reade Deleacy ^c, Gal Yaniv ^c, Max Wintermark ^d, David S. Liebeskind ^e, Hazem Shoirah ^c, J Mocco ^c
^a Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095, USA
^b Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
^c Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
^d Department of Radiology, Stanford University, Paolo Alto, CA, 10029, USA
^e Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095, USA

^⁎Corresponding author.

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Abstract

Background & Purpose: Perfusion collateral index (PCI) has been recently defined as a promising measure of collateral status. We sought to compare collateral status assessed via CT-PCI in comparison to single-phase CTA and their relationship to outcome measures including final infarction volume, final recanalization status and functional outcome in ELVO patients.

Methods: ELVO patients with anterior circulation large vessel occlusion who had baseline CTA and CT perfusion and underwent endovascular treatment were included. Collateral status was assessed on CTA. PCI from CT perfusion was calculated in each patient and an optimal threshold to separate good vs insufficient collaterals was identified using DSA as reference. The collateral status determined by CTA and PCI were assessed against 3 measured outcomes: 1) final infarction volume; 2) final recanalization status defined by TICI scores; 3) functional outcome measured by 90-day mRS.

Results: A total of 53 patients met inclusion criteria. Excellent recanalization defined by TICI ≥2C was achieved in 36 (68%) patients and 23 patients (43%) had good functional outcome (mRS ≤2). While having good collaterals on both CTA and CTP-PCI was associated with significantly (p<0.05) smaller final infarction volume, only good collaterals status determined by CTP-PCI was associated with achieving excellent recanalization (p = 0.001) and good functional outcome (p = 0.003).

Conclusion: CTP-based PCI outperforms CTA collateral scores in determination of excellent recanalization and good functional outcome and may be a promising imaging marker of collateral status in patients with delayed presentation of AIS.

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Graphic abstract

CTP-based perfusion collateral index outperforms CTA collateral scores in determination of excellent recanalization and good functional outcome and may be a promising imaging biomarker of collateral status in patients with acute ischemic stroke