Neurology Medical News about acute ischemic stroke;computed tomography angiographic collateral status

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The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke
Brain, 06/11/09

Miteff F et al. – In pts with proximal vessel occlusion, perfusion computed tomography (CT) mismatch is a prerequisite for a favourable clinical response, but good collateral status appears a critical determinant of ultimate outcome, particularly if major reperfusion occurs.

Methods

Study of whether collateral vessel status on computed tomography (CT) angiography can predict the fate of penumbral tissue identified on perfusion CT and thus influence clinical outcome
Assessment of consecutive patients who had perfusion CT / CT angiography within 6 hr of anterior circulation stroke, repeat perfusion/infarct volume imaging at 24 hr, and modified Rankin Scale at 3 mo
Gracing of collateral status as good or reduced depending on extent of contrast visualized distal to occlusion on CT angiography
Calculation of perfusion CT mismatch ratio from ratio of mean transit time lesion/cerebral blood volume lesion

Results

Of 92 pts with proximal intracranial vessel occlusion, good collateral status (51/92) significantly associated with reduced infarct expansion and more favourable functional outcomes (modified Rankin Scale 0–2)
Significant univariate predictors of favorable outcome: good collateral status, major reperfusion at 24 hr, presence of perfusion CT mismatch and baseline National Institutes of Health Stroke Scale score
None of 37 pts with a perfusion CT mismatch ratio < 3.0 had a favorable outcome
In pts with perfusion CT mismatch, significant independent predictors of favorable outcome: good collateral status, major reperfusion and baseline National Institutes of Health Stroke Scale score
Strong interaction between major reperfusion and good collateral status in regression models

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