title: CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review.
abstract: BACKGROUND
  Acute ischemic stroke (AIS) due to emergent large-vessel occlusion (ELVO) has a poor prognosis.
  
  
  OBJECTIVE
  To examine the hypothesis that a better collateral score on pretreatment CT angiography (CTA) would correlate with a smaller final infarct volume and a more favorable clinical outcome after endovascular therapy (EVT).
  
  
  METHODS
  A retrospective chart review of the University of Tennessee AIS database from February 2011 to February 2013 was conducted. All patients with CTA-proven LVO treated with EVT were included. Recanalization after EVT was defined by Thrombolysis in Cerebral Infarction (TICI) score ≥2. Favorable outcome was assessed as a modified Rankin Score ≤3.
  
  
  RESULTS
  Fifty patients with ELVO were studied. The mean National Institutes of Health Stroke Scale score was 17 (2-27) and 38 of the patients (76%) received intravenous tissue plasminogen activator. The recanalization rate for EVT was 86.6%. Good clinical outcome was achieved in 32% of patients. Univariate predictors of good outcome included good collateral scores (CS) on presenting CTA (p=0.043) and successful recanalization (p=0.02). Multivariate analysis confirmed both good CS (p=0.024) and successful recanalization (p=0.009) as predictors of favorable outcome. Applying results of the multivariate analysis to our cohort we were able to determine the likelihood of good clinical outcome as well as predictors of smaller final infarct volume after successful recanalization.
  
  
  CONCLUSIONS
  Good CS predict smaller infarct volumes and better clinical outcome in patients recanalized with EVT. These data support the use of this technique in selecting patients for EVT. Poor CS should be considered as an exclusion criterion for EVT as patients with poor CS have poor clinical outcomes despite recanalization.
authors.affiliation: Department of Neurology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Elijovich
authors.affiliation: Department of Neurology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA.
authors.forename: Shraddha
authors.initials: S
authors.lastname: Mainali
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Hoit
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Arthur
authors.affiliation: Department of Radiology, George Washington University, Washington DC, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Whitehead
authors.affiliation: Department of Radiology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
authors.forename: Asim F
authors.initials: AF
authors.lastname: Choudhri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000628:therapy; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures; D006801:Humans; D008875:Middle Aged; D011300:Preoperative Care; D015424:Reperfusion / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy; D016896:Treatment Outcome
keywords: CT Angiography; Stroke