Quantitative insights into stroke recovery utilizing delayed vessel ratio from color-coded multiphase computed tomography angiography

Predicting recovery is totally fucking useless. DELIVER EXACT RECOVERY PROTOCOLS! I'd fire anyone doing prediction research, it's useless!

 Quantitative insights into stroke recovery utilizing delayed vessel ratio from color-coded multiphase computed tomography angiography

Yu Lin1,2,3†, Xiaoxiao Zhang2†, Zhen Xing1, Xiefeng Yang1, Qingwen Tong4, Shaomao Lv2, Jinan Wang2,3 and Dairong Cao1,5,6,7*

1Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China

2Department of Radiology, Zhongshan Hospital Affiliated to Xiamen University, School of Clinical Medicine of Fujian Medical University, Xiamen, China

3Xiamen Radiology Quality Control Center, Zhongshan Hospital Affiliated to Xiamen University, School of Clinical Medicine of Fujian Medical University, Xiamen, China

4Department of Health Examination, Xiamen Humanity Hospital Fujian Medical University, Xiamen, China

5Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China

6Fujian Provincial Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China

7Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China

Edited by

Alan Wang, The University of Auckland, New Zealand

Reviewed by

Rodrigo Assar, University of Chile, Chile

Jihoon Kang, Seoul National University Bundang Hospital, Republic of Korea

*Correspondence

Dairong Cao, dairongcao@163.com

†These authors have contributed equally to this work and share first authorship

Received 30 January 2025

Accepted 03 June 2025

Published 18 June 2025

Citation

Lin Y, Zhang X, Xing Z, Yang X, Tong Q, Lv S, Wang J and Cao D (2025) Quantitative insights into stroke recovery utilizing delayed vessel ratio from color-coded multiphase computed tomography angiography. Front. Neurol. 16:1568717. doi: 10.3389/fneur.2025.1568717

Background and objective: 

The color-coded multiphase computed tomography angiography (cmCTA) is an accredited technique that employs color-coding to visually depict the temporal dynamics of collateral blood flow in patients with acute ischemic stroke (AIS). This research aimed to assess the quantification of cmCTA in AIS patients for characterizing arterial and venous collateral flow, and predicting functional outcomes.

Methods: 

A retrospective study was performed on a consecutive cohort of AIS patients with large vessel occlusion who underwent cmCTA scan and reconstruction. Collateral ratio and delayed vessel ratio (DVR) were determined through semi-automatic delineation and calculation on the anterior cerebral artery regions and Alberta Stroke Program Early CT (ASPECT) Score regions of cmCTA maps. Deep venous outflow (DVO) and superficial venous outflow (SVO) scores were assessed using a 6-point scale. Logistic regression and propensity score were applied to confounding factors adjustment and model construction. Receiver operating characteristic curve, calibration curve, and decision curve analysis were utilized to evaluate the prediction model of functional independence and excellent recovery.

Results: 

Well-developed arterial collaterals as depicted by low DVR and adequate venous collaterals as indicated by high DVO or SVO were correlated with better outcomes (All p < 0.001). Adjusted DVR showed areas under the curve of 0.81–0.90 for predicting functional independence and excellent recovery. Adjusted DVO showed areas under the curve of 0.88 for predicting functional independence and excellent recovery. Each prediction model demonstrated good precision and net benefit.

Conclusion: 

The application of DVR and other parameters in cmCTA offers a quantitative perspective on the conventional ASPECT scoring scheme utilizing grayscale CT images. DVR from cmCTA may enhance pre-treatment collateral assessment and post-treatment outcome prediction in AIS, facilitating informed treatment decisions.

Keywords

computed tomography angiography; collateral circulation; stroke; delayed vessel ratio; venous outflow

Impact of collateral circulation on early outcome and risk of hemorrhagic complications after systemic thrombolysis

Maybe the stroke world is finally getting the idea that blood flow to the penumbra is essential immediately after the stroke. Otherwise the neuronal cascade of death will kills lots of neurons. But they don't mention pericytes.
http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2012.00922.x/abstract;jsessionid=64AF10A8E750D042FE3C30B89DE55D6E.d02t02

Background

In stroke patients, collateral flow can rapidly be assessed on computed tomography angiography (CTA).

Aims

In this study, the impact of baseline collaterals on early outcome and risk of symptomatic intracerebral hemorrhages after systemic thrombolysis in patients with proximal arterial occlusions within the anterior circulation were analyzed.

Methods

Collateralization scores were determined on the CT angiography source images (0 = absent; 1 ≤ 50%, 2 greater than 50% but less than 100%, and 3 = 100% collateral filling) of patients with distal intracranial carotid artery and/or M1 segment occlusions treated from 2008 to December 2011. A collateral score of 0 to 1 was designated as poor and 2 to 3 as good collateral vessel status. Outcome variables included in hospital mortality, favorable outcome at discharge (modified Rankin score ≤ 2), and rates of symptomatic intracerebral hemorrhage based on the European–Australasian Acute Stroke Study II definition.

Results

Among 246 subjects (mean age of 74 years; median National Institutes of Health Stroke Scale N at admission 14), 205 patients (83%) had good collaterals, whereas 41 patients (17%) had poor collaterals, respectively. Patients with poor collaterals had significantly higher rates of in-hospital mortality (41% vs. 12%, P less than 0·001), of symptomatic intracerebral hemorrhage (15% vs. 4·9%, P less than 0·05) and had significantly lower rates of favorable early clinical outcome (0% vs. 28%, P  less than 0·001) compared with those with good collaterals. The grade of collateralization was independently associated with in-hospital mortality (P less than 0·001), early clinical outcome (P less than 0·01), and rates of symptomatic intracerebral hemorrhage (P less than 0·01).

Conclusion

Patients with proximal arterial occlusions within the anterior circulation and poor baseline collaterals have a poor early functional outcome and high rates of symptomatic intracerebral hemorrhage after systemic thrombolysis. Since similar findings have also been reported after endovascular therapy, strategies to improve collateral blood flow should be assessed in this patient population.