Performance of computed tomography angiography to determine anterograde and collateral blood flow status in patients with symptomatic middle cerebral artery stenosis

Abstract

Background

The purpose of this study was to determine the performance of computed tomography angiography (CTA) by using a scoring system to predict anterograde and collateral blood flow status in patients with symptomatic middle cerebral artery (MCA) stenosis with use of conventional angiography as standard reference.

Methods

We retrospectively identified all consecutive patients with unilateral symptomatic MCA stenosis in our center who underwent conventional angiography and CTA within 1 month. The anterograde and collateral blood flow (AnCo) scoring system consisted of anterograde score (AnS) and collateral score (CoS). Evaluation of the CTA images was done independently by two readers, based on the AnCo scoring system. The conventional angiography was assessed by using the Thrombolysis in Cerebral Infarction (TICI) and American Society of Interventional and Therapeutic Neuroradiology (ASITN/SIR) scoring system to determine the status of anterograde and collateral blood flow. Diagnostic performance of AnCo was evaluated by using the area under the receiver operating characteristic (ROC) curve.

Results

A total of 61 patients were included in the analysis with mean age of 53.4 ± 11.0 years. AnS demonstrated a strong correlation with TICI with statistical significance (r = 0.786; p < 0.001). CoS had a modest yet statistically significant correlation with ASITN/SIR (r = 0.574; p < 0.001). The ROC curve analysis for AnS demonstrated an area under the curve (AUC) of 0.894 (p < 0.001) and the ROC curve analysis for CoS showed an AUC of 0.824 (p < 0.001).

Conclusions

CTA was a potential method to evaluate anterograde and collateral blood flow status in patients with symptomatic unilateral MCA stenosis.

Keywords

Intracranial atherosclerosis collaterals computed tomography angiography

Get full access to this article

View all access options for this article.

References

Qureshi

Caplan

. Intracranial atherosclerosis. Lancet 2014; 383: 984–998.

Chimowitz

Lynn

Derdeyn

. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011; 365: 993–1003.

Liebeskind

Cotsonis

Saver

. Collaterals dramatically alter stroke risk in intracranial atherosclerosis. Ann Neurol 2011; 69: 963–974.

Lau

Wong

. Significance of good collateral compensation in symptomatic intracranial atherosclerosis. Cerebrovasc Dis 2012; 33: 517–524.

Leng

Wong

Liebeskind

. Evaluating intracranial atherosclerosis rather than intracranial stenosis. Stroke 2014; 45: 645–651.

Higashida

Furlan

Roberts

. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. J Vasc Interv Radiol 2003; 14: S493–S494.

Kortman

Smit

Oei

. 4d-cta in neurovascular disease: A review. AJNR Am J Neuroradiol 2015; 36: 1026–1033.

Leng

Scalzo

. Computational fluid dynamics modeling of symptomatic intracranial atherosclerosis may predict risk of stroke recurrence. PLoS One 2014; 9: e97531.

Power

McEvoy

Cunningham

. Value of CT angiography in anterior circulation large vessel occlusive stroke: Imaging findings, pearls, and pitfalls. Eur J Radiol 2015; 84: 1333–1344.

10.

Leng

Fang

Leung

. Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: A systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2016; 87: 537–544.

11.

McVerry

Liebeskind

Muir

. Systematic review of methods for assessing leptomeningeal collateral flow. AJNR Am J Neuroradiol 2012; 33: 576–582.

12.

Menon

Smith

Modi

. Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions. AJNR Am J Neuroradiol 2011; 32: 1640–1645.

13.

Maas

Lev

. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke 2009; 40: 3001–3005.

14.

Miteff

Levi

Bateman

. The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke. Brain 2009; 132: 2231–2238.

15.

Lee

Cho

Byun

. Triphasic perfusion computed tomography in acute middle cerebral artery stroke: A correlation with angiographic findings. Arch Neurol 2000; 57: 990–999.

16.

Tan

Demchuk

Hopyan

. CT angiography clot burden score and collateral score: Correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 2009; 30: 525–531.

17.

Lyu

Liebeskind

. Arterial spin labeling magnetic resonance imaging estimation of antegrade and collateral flow in unilateral middle cerebral artery stenosis. Stroke 2016; 47: 428–433.

18.

Han

Liu

Chen

. Severity assessment of intracranial large artery stenosis by pressure gradient measurements: A feasibility study. Catheter Cardiovasc Interv 2016; 88: 255–261.

19.

Menon

O'Brien

Bivard

. Assessment of leptomeningeal collaterals using dynamic CT angiography in patients with acute ischemic stroke. J Cereb Blood Flow Metab 2013; 33: 365–371.