title: Predictive value of the velocity of collateral filling in patients with acute ischemic stroke.
abstract: The velocity of collateral filling can be assessed in dynamic time-resolved computed tomography (CT) angiographies and may predict initial CT perfusion (CTP) and follow-up lesion size. We included all patients with an M1± internal carotid artery (ICA) occlusion and follow-up imaging from an existing cohort of 1791 consecutive patients who underwent multimodal CT for suspected stroke. The velocity of collateral filling was quantified using the delay of time-to-peak (TTP) enhancement of the M2 segment distal to the occlusion. Cerebral blood volume (CBV) and mean transit time (MTT)-CBV mismatch were assessed in initial CTP. Follow-up lesion size was assessed by magnetic resonance imaging (MRI) or non-enhanced CT (NECT). Multivariate analyses were performed to adjust for extent of collateralization and type of treatment. Our study comprised 116 patients. Multivariate analysis showed a short collateral blood flow delay to be an independent predictor of a small CBV lesion (P<0.001) and a large relative mismatch (P<0.001) on initial CTP, of a small follow-up lesion (P<0.001), and of a small difference between initial CBV and follow-up lesion size (P=0.024). Other independent predictors of a small lesion on follow-up were a high morphologic collateral grade (P=0.001), lack of an additional ICA occlusion (P=0.009), and intravenous thrombolysis (P=0.022). Fast filling of collaterals predicts initial CTP and follow-up lesion size and is independent of extent of collateralization.
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Sebastian E
authors.initials: SE
authors.lastname: Beyer
authors.affiliation: Department of Neurology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Louisa
authors.initials: L
authors.lastname: von Baumgarten
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Kolja M
authors.initials: KM
authors.lastname: Thierfelder
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Marietta
authors.initials: M
authors.lastname: Rottenkolber
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Janssen
authors.affiliation: Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Dichgans
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Thorsten Rc
authors.initials: TR
authors.lastname: Johnson
authors.affiliation: Department of Neurology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Straube
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Ertl-Wagner
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Wieland H
authors.initials: WH
authors.lastname: Sommer
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed