Abstract Details

Title CTA Collaterals, HIR, and Infarct Volume: Which Imaging Modality Best Predicts Clinical Outcomes in Acute Ischemic Stroke Endovascular Treatment?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S2 - Advances in Stroke Imaging and Biomarkers (3:00 PM-3:12 PM)

Poster/Presentation
Number 010

Objective To compare different radiographic modalities and their ability to predict functional outcome in patients with acute ischemic stroke (AIS) undergoing Endovascular Thrombectomy (EVT).

Background Leptomeningeal collateral (LMC) status is associated with clinical outcome after AIS treatment. Multiple radiographic modalities have been proposed to assess collateral status. Nevertheless, there is a scarcity of studies regarding their clinical relevance as well as association with clinical outcomes.

Design/Methods In this retrospective study, we included AIS patients presenting with ICA or M1 occlusion undergoing EVT with a pre-event mRS score of ≤2. CTA collaterals were classified using the Regenhardt et al. Patients were categorized into three groups—malignant, intermediate, and symmetric. CTP Hypoperfusion Intensity Ratio (HIR) was calculated by dividing the volume of tissue with a time-to-maximum (Tmax) of >10 seconds by Tmax of >6 seconds. CTP Infarct Volume (IV) was defined as Cerebral blood flow > 30%. Associations between each marker and mRS was assessed using the Kruskal-Wallis test, and stepwise fitting of different variables within univariable, then multivariable regression analyses.

Results A total of 155 patients were included in this study. 53% of them were males, and 47% were females. 43% of patients had symmetrical collaterals, while 19% had malignant collaterals. The mean CTP IV was 28±3.7, and mean CTP HIR was 0.4±0.02. CTA collateral score was associated with 90-days mRS across all statistical analysis methods, while CTP HIR was not associated with outcomes. CTP IV was only associated with outcomes when analyzed as a continuous variable.

Conclusions

Visual analyses of CTA collaterals appears to be better than using automated CTP measures in predicting stroke outcomes. While absolute CTP infract volume seems to be correlate with 90-days mRS, no effective dichotomous cut-point was identified.

Authors/Disclosures
Mohammed Qussay Ali Al-Sabbagh, MD (University of Kansas Medical Center) PRESENTER	Dr. Al-Sabbagh has nothing to disclose.
Sai Kumar Reddy Pasya, MD, MBBS (University of Kansas Medical Center)	Dr. Pasya has nothing to disclose.
Tuqa Asedi, MD	Dr. Asedi has nothing to disclose.
Mahdi Q. Sabbagh	Dr. Sabbagh has nothing to disclose.
Hussein Alsadi (University of Kansas Medical Center)	Hussein Alsadi has nothing to disclose.
Prasanna Venkatesan Eswaradass, MD (University of Kansas Health System)	Dr. Eswaradass has nothing to disclose.

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