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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(03): s00441779268
DOI: 10.1055/s-0044-1779268
Original Article

Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome

Avaliação da relação entre escores colaterais da angiotomografia computadorizada e evolução clínica

Authors

  • Ahmet Yabalak 

    1   Duzce University, Faculty of Medicine, Department of Neurology, Duzce, Türkiye.

  • Muhammed Nur Ögün 

    2   Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.

  • Ayşenur Önalan 

    3   Kartal Lutfi Kırdar City Hospital, Department of Neurology, Istanbul, Türkiye.

  • Murat Yılmaz 

    2   Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.

  • Hilmiye Tokmak 

    2   Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.

  • Sadettin Ersoy 

    2   Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.

  • Fatma Bilgili 

    2   Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.

  • Tahsin Bakkal 

    2   Bolu Abant Izzet Baysal University, Department of Neurology, Bolu, Türkiye.
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Abstract

Background The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies.

Objective In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used.

Methods Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated.

Results Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS ≤ 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis.

Conclusion mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.

Resumo

Antecedentes A relação entre circulação colateral e prognóstico após tratamento endovascular em acidentes vasculares cerebrais de circulação anterior tem sido relatada em muitos estudos.

Objetivo Neste estudo, nosso objetivo foi comparar o poder preditivo do desfecho clínico comparando cinco escores colaterais diferentes que são frequentemente utilizados.

Métodos Entre os pacientes submetidos a tratamento endovascular em nossa clínica entre novembro de 2019 e dezembro de 2021, foram incluídos no estudo pacientes com mRS pré-mórbido < 3, oclusão intracraniana de ICA e/ou MCA M1 e exame de CTA multifásico pré-procedimento. Foram registradas informações demográficas, técnicas e de duração sobre o procedimento, eventos importantes após o procedimento e resultados clínicos em três meses. Foram avaliados os escores colaterais mCTA, Tan, Maas, Miteff e rLMC dos pacientes.

Resultados Os resultados clínicos aos três meses foram bons em 37 dos 68 pacientes incluídos no estudo (mRS ≤ 2). Apenas os escores colaterais mCTA e rLMC foram estatisticamente significativamente maiores naqueles com boa evolução clínica. Correlação significativa com mRS de três meses foi detectada apenas nos escores mCTA e rLMC. Embora os escores colaterais de rLMC e mCTA tenham mostrado uma associação estatisticamente significativa com o prognóstico, eles não foram suficientes para serem um preditor independente de prognóstico.

Conclusão Verificou-se que mCTA e rLMC têm o maior poder preditivo do resultado clínico e a maior correlação com o resultado clínico de três meses. Nosso estudo sugere que seria benéfico desenvolver um novo sistema de pontuação em vez de CTA multifásico, que combinasse avaliação regional e temporal, que são os pontos fortes de ambas as pontuações colaterais.

Keywords

Stroke - Collateral Circulation - Endovascular Procedures - Thrombectomy - Computed Tomography Angiography

Palavras-chave

Acidente Vascular Cerebral - Circulação Colateral - Procedimentos Endovasculares - Trombectomia - Angiografia por Tomografia Computadorizada

Authors' Contributions

AY: conceptualization, data curation, formal analysis, funding acquisition, ınvestigation, methodology, resources, software, validation, visualization, writing – original draft, writing – review & editing; MNO: conceptualization, formal analysis, funding acquisition, ınvestigation, methodology, resources, software, supervision, validation, visualization, writing – original draft, writing – review & editing; AO: data curation, formal analysis, visualization, writing – original draft; MY: data curation, formal analysis, ınvestigation, writing – original draft; HT, FB, SE, TB: data curation, writing – original draft.




Publication History

Received: 23 June 2023

Accepted: 11 November 2023

Article published online:
04 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Ahmet Yabalak, Muhammed Nur Ögün, Ayşenur Önalan, Murat Yılmaz, Hilmiye Tokmak, Sadettin Ersoy, Fatma Bilgili, Tahsin Bakkal. Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome. Arq Neuropsiquiatr 2024; 82: s00441779268.
DOI: 10.1055/s-0044-1779268