Deans' stroke musings: Preliminary Application of a Quantitative Collateral Assessment Method in Acute Ischemic Stroke Patients With Endovascular Treatments: A Single-Center Study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, January 4, 2022

Preliminary Application of a Quantitative Collateral Assessment Method in Acute Ischemic Stroke Patients With Endovascular Treatments: A Single-Center Study

So you are still predicting failure to recover and provided nothing on interventions needed to recover. Useless.

Preliminary Application of a Quantitative Collateral Assessment Method in Acute Ischemic Stroke Patients With Endovascular Treatments: A Single-Center Study

Ruoyao Cao^1,2,

Peng Qi³,

Yun Jiang⁴,

Shen Hu³,

Gengfan Ye⁵,

Yaxin Zhu⁶,

Ling Li^2,7,

Zilong You² and

Juan Chen²^*

¹Graduate School of Peking Union Medical College, Beijing, China
²Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
³Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
⁴Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
⁵Department of Neurosurgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
⁶CT Clinical Research Department, CT Business Unit, Canon Medical Systems (China) Co., Ltd., Beijing, China
⁷Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China

Objectives: To develop an efficient and quantitative assessment of collateral circulation on time maximum intensity projection CT angiography (tMIP CTA) in patients with acute ischemic stroke (AIS).

Methods: Eighty-one AIS patients who underwent one-stop CTA-CT perfusion (CTP) from February 2016 to October 2020 were retrospectively reviewed. Single-phase CTA (sCTA) and tMIP CTA were developed from CTP data. Ischemic core (IC) volume, ischemic penumbra volume, and mismatch ratio were calculated. The Tan scale was used for the qualitative evaluation of collateral based on sCTA and tMIP CTA. Quantitative collateral circulation (CCq) parameters were calculated semi-automatically with software by the ratio of the vascular volume (V) on both hemispheres, including tMIP CTA V_CCq and sCTA V_CCq. Spearman correlation analysis was used to analyze the correlation of collateral-related parameters with final infarct volume (FIV). ROC and multivariable regression analysis were calculated to compare the significance of the above parameters in clinical outcome evaluation. The analysis time of the observers was also compared.

Results: tMIP CTA V_CCq (r = 0.61, p < 0.01), IC volume (r = 0.66, p < 0.01), Tan score on tMIP CTA (r = 0.52, p < 0.01) and mismatch ratio (r = 0.60, p < 0.01) showed moderate negative correlations with FIV. tMIP CTA V_CCq showed the best prognostic value for clinical outcome (AUC = 0.93, p < 0.001), and was an independent predictive factor of clinical outcome (OR = 0.14, p = 0.009). There was no difference in analysis time of tMIP CTA V_CCq among observers (p = 0.079).

Conclusion: The quantitative evaluation of collateral circulation on tMIP CTA is associated with clinical outcomes in AIS patients with endovascular treatments.

Introduction

Reperfusion therapies significantly improve the prognosis of patients with acute ischemic stroke (AIS). With the popularization of endovascular treatments (EVTs) in AIS, it is necessary to build an individualized evaluation system, helping physicians make clinical decisions and predict outcomes before invasive intervention (1, 2). Previous studies have indicated that collateral circulation is one of the main factors determining ischemic penumbra (3–6). Comprehensive and accurate evaluation of collateral circulation is a necessary complement to develop individualized treatments for AIS patients.

The visibility of the collateral circulation on computed tomography angiography (CTA) strongly depends on the acquisition time. The strength of the collateral flow is more important to tissue fate than the velocity of collateral filling (7). Because the interindividual collateral circulation (distribution, filling time, etc.) is highly variable and the optimal acquisition time is individually different, four-dimensional CTA (4D CTA) obtained from the perfusion data (multi-time frame) was applied to evaluate collateral status more accurately (7–9). Time maximum intensity projection angiography (tMIP CTA), also known as timing-invariant (TI) CTA (10) or temporally fused maximum intensity projection (tMIP) CTA (7), reflects the maximum value on all projection planes scrolling over time, producing a new volume-based data packet that is generated from all phases images of CT perfusion (CTP). tMIP CTA may eliminate the drawback of single-phase CTA (sCTA) wherein collateral vessels are usually displayed incompletely due to delayed pathophysiology status, building a system with high temporal and spatial resolution (7, 8, 10–12). Thus, tMIP CTA improves the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of images and may therefore be an ideal option for assessing collateral circulation (7, 8, 12).

Until now, there has been no unified collateral circulation evaluation system. Several grading scales have been applied in collateral circulation evaluation, including the CTA-based Miteff scale (13), the modified Tan scale (14), and the regional leptomeningeal collateral score (rLMC) (15). It is difficult to verify the predictive value, reliability, and validity of these different scoring systems. Therefore, a standardized evaluation model is needed. Here, we adopted a simple and efficient quantitative assessment based on tMIP CTA to evaluate collateral circulation status.

In this study, we assessed whether this new quantitative assessment system was able to evaluate collateral circulation accurately in comparison with the qualitative collateral score system and CTP. Additionally, the analysis time among observers with different levels of experience was also compared. We aimed to identify an efficient and highly accurate quantitative method for evaluating collateral circulation during the decision-making process.