Multiphase CTA Collateral Circulation is an Excellent CT Indicator than CT ASPECTS in Predicting Clinical Outcome in Acute Ischemic Stroke
Pipat Chiewvit¹, Pongsathorn Ampornjarut², Yongchai Nilanont², Chanon Ngamsombat¹
Affiliation : ¹ Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; ² Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective: The prognosis of acute ischemic stroke patients is influenced by collateral vasculature. The present study aimed to evaluate the predictive value of the initial collateral circulation score (ICS) obtained from multiphase computed tomography angiography (mCTA) in determining clinical outcomes. The authors hypothesized that the initial mCTA collateral circulation score may serve as a superior predictor of clinical outcomes compared to the CT Alberta Stroke Program Early CT Score (ASPECTS). Additionally, the first phase CTA ASPECTS (f-CTA ASPECTS) derived from mCTA may offer enhanced predictive accuracy over the CT ASPECTS.
Materials and Methods: The authors conducted a retrospective analysis of 300 patients diagnosed with acute ischemic stroke between 2020 and 2021. Collateral scores were assessed using mCTA, and the first phase CTA ASPECTS score was also evaluated. Clinical outcomes were measured using the modified Rankin Scale (mRS) at hospital discharge, categorizing outcomes as good with mRS 0 to 2, or poor with mRS 3 to 6. Both univariate and multiple linear regression models were employed to predict patient outcomes.
Results: Univariate analysis demonstrated a significant association between both the collateral score and first phase CTA ASPECTS with clinical outcomes. However, in the multiple linear regression model, only the CTA ASPECTS emerged as a significant predictor of discharge mRS. The model accounted for 45.7% of the variance in mRS at discharge. A comparison of the reperfusion and non-reperfusion groups with good collateral scores revealed no significant difference in discharge mRS outcomes (p=0.954).
Conclusion: While both the collateral score and the first phase CTA ASPECTS were associated with clinical outcomes, only the first phase CTA ASPECTS was a statistically significant predictor of mRS at discharge. The absence of a difference in mRS outcomes between reperfusion and non-reperfusion groups among patients with initially good collateral scores on mCTA suggested that aggressive reperfusion procedures may not always be warranted.
Received 10 February 2025 | Revised 23 April 2025 | Accepted 28 April 2025
DOI: 10.35755/jmedassocthai.2025.7.526-533-02688
Keywords : Multiphase CTA brain; CT brain; CT ASPECT score; Collateral score
