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Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window?

PURPOSE: Although endovascular treatment is currently thought to only be suitable for patients who have pial arterial filling scores >3 as determined by multiphase computed tomography angiography (mpCTA), a cut-off score of 3 was determined by a study, including patients within 12 hours after sym...

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Autores principales: Woo, Ho Geol, Jung, Cheolkyu, Sunwoo, Leonard, Bae, Yun Jung, Choi, Byung Se, Kim, Jae Hyoung, Kim, Beom Joon, Han, Moon-Ku, Bae, Hee-Joon, Jung, Seunguk, Cha, Sang-Hoon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Interventional Neuroradiology 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736504/
https://www.ncbi.nlm.nih.gov/pubmed/31302985
http://dx.doi.org/10.5469/neuroint.2019.00080
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author Woo, Ho Geol
Jung, Cheolkyu
Sunwoo, Leonard
Bae, Yun Jung
Choi, Byung Se
Kim, Jae Hyoung
Kim, Beom Joon
Han, Moon-Ku
Bae, Hee-Joon
Jung, Seunguk
Cha, Sang-Hoon
author_facet Woo, Ho Geol
Jung, Cheolkyu
Sunwoo, Leonard
Bae, Yun Jung
Choi, Byung Se
Kim, Jae Hyoung
Kim, Beom Joon
Han, Moon-Ku
Bae, Hee-Joon
Jung, Seunguk
Cha, Sang-Hoon
author_sort Woo, Ho Geol
collection PubMed
description PURPOSE: Although endovascular treatment is currently thought to only be suitable for patients who have pial arterial filling scores >3 as determined by multiphase computed tomography angiography (mpCTA), a cut-off score of 3 was determined by a study, including patients within 12 hours after symptom onset. We aimed to investigate whether a cut-off score of 3 for endovascular treatment within 6 hours of symptom onset is an appropriate predictor of good functional outcome at 3 months. MATERIALS AND METHODS: From April 2015 to January 2016, acute ischemic stroke patients treated with mechanical thrombectomy within 6 hours of symptom onset were enrolled into this study. Pial arterial filling scores were semi-quantitatively assessed using mpCTA, and clinical and radiological parameters were compared between patients with favorable and unfavorable outcomes. Multivariate logistic regression analysis was then performed to investigate the independent association between clinical outcome and pial collateral score, with the predictive power of the latter assessed using C-statistics. RESULTS: Of the 38 patients enrolled, 20 (52.6%) had a favorable outcome and 18 had an unfavorable outcome, with the latter group showing a lower mean pial arterial filling score (3.6±0.8 vs. 2.4±1.2, P=0.002). After adjusting for variables with a P-value of <0.1 in univariate analysis (i.e., age and National Institutes of Health Stroke Scale score at admission), pial arterial filling scores higher than a cut-off of 2 were found to be independently associated with favorable clinical outcomes (P=0.012). C-statistic analysis confirmed that our model had the highest prediction power when pial arterial filling scores were dichotomized at >2 vs. ≤2. CONCLUSION: A pial arterial filling cut-off score of 2 as determined by mpCTA appears to be more suitable for predicting clinical outcomes following endovascular treatment within 6 hours of symptom onset than the cut-off of 3 that had been previously suggested.
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spelling pubmed-67365042019-09-19 Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window? Woo, Ho Geol Jung, Cheolkyu Sunwoo, Leonard Bae, Yun Jung Choi, Byung Se Kim, Jae Hyoung Kim, Beom Joon Han, Moon-Ku Bae, Hee-Joon Jung, Seunguk Cha, Sang-Hoon Neurointervention Original Paper PURPOSE: Although endovascular treatment is currently thought to only be suitable for patients who have pial arterial filling scores >3 as determined by multiphase computed tomography angiography (mpCTA), a cut-off score of 3 was determined by a study, including patients within 12 hours after symptom onset. We aimed to investigate whether a cut-off score of 3 for endovascular treatment within 6 hours of symptom onset is an appropriate predictor of good functional outcome at 3 months. MATERIALS AND METHODS: From April 2015 to January 2016, acute ischemic stroke patients treated with mechanical thrombectomy within 6 hours of symptom onset were enrolled into this study. Pial arterial filling scores were semi-quantitatively assessed using mpCTA, and clinical and radiological parameters were compared between patients with favorable and unfavorable outcomes. Multivariate logistic regression analysis was then performed to investigate the independent association between clinical outcome and pial collateral score, with the predictive power of the latter assessed using C-statistics. RESULTS: Of the 38 patients enrolled, 20 (52.6%) had a favorable outcome and 18 had an unfavorable outcome, with the latter group showing a lower mean pial arterial filling score (3.6±0.8 vs. 2.4±1.2, P=0.002). After adjusting for variables with a P-value of <0.1 in univariate analysis (i.e., age and National Institutes of Health Stroke Scale score at admission), pial arterial filling scores higher than a cut-off of 2 were found to be independently associated with favorable clinical outcomes (P=0.012). C-statistic analysis confirmed that our model had the highest prediction power when pial arterial filling scores were dichotomized at >2 vs. ≤2. CONCLUSION: A pial arterial filling cut-off score of 2 as determined by mpCTA appears to be more suitable for predicting clinical outcomes following endovascular treatment within 6 hours of symptom onset than the cut-off of 3 that had been previously suggested. Korean Society of Interventional Neuroradiology 2019-09 2019-07-15 /pmc/articles/PMC6736504/ /pubmed/31302985 http://dx.doi.org/10.5469/neuroint.2019.00080 Text en Copyright © 2019 Korean Society of Interventional Neuroradiology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Paper
Woo, Ho Geol
Jung, Cheolkyu
Sunwoo, Leonard
Bae, Yun Jung
Choi, Byung Se
Kim, Jae Hyoung
Kim, Beom Joon
Han, Moon-Ku
Bae, Hee-Joon
Jung, Seunguk
Cha, Sang-Hoon
Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window?
title Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window?
title_full Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window?
title_fullStr Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window?
title_full_unstemmed Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window?
title_short Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window?
title_sort dichotomizing level of pial collaterals on multiphase ct angiography for endovascular treatment in acute ischemic stroke: should it be refined for 6-hour time window?
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736504/
https://www.ncbi.nlm.nih.gov/pubmed/31302985
http://dx.doi.org/10.5469/neuroint.2019.00080
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