title: A Combined Arterial and Venous Grading Scale to Predict Outcome in Anterior Circulation Ischemic Stroke.
abstract: OBJECTIVE
  Prognostic evaluation based on cortical vein score difference in stroke (PRECISE) score, a novel venous grading scale better predicted stroke outcomes. Henceforth, we aimed to describe and determine if a physiologically relevant combined arterial and venous grading scale (CRISP grading scale) is accurate in determining 90-day stroke outcomes in patients with proximal arterial occlusion in the anterior circulation.
  
  
  METHODS
  Data are from the Keimyung Stroke Registry. Consecutive patients with M1 middle cerebral artery (MCA) or terminal internal carotid artery (ICA) occlusion on CT-angiography (CTA) from May-2004 to July-2008 were included. The affected hemisphere 'four veins composite score' and 'arterial collaterals' were each graded 'good' and 'poor'. On the combined scale, a 'good' grade represented a 'good' score on both scales and a 'poor' grade represented a 'poor' score on both scales. The 'other two' combinations were graded 'intermediate.'
  
  
  RESULTS
  Eighty-one patients were included in the study. Dummy variable regression analysis demonstrated that poor outcome was commonly seen in the group with poor arterial and venous grades [OR(95%CI); 48 (8.24, 279.598); P < 0.00001] as opposed to poor arterial collaterals alone [OR(95%CI); 9.6(1.483,62.162); P = 0.018]. In multivariate analysis the CRISP grade [OR(95%CI); 2.638(1.192, 6.039), P = 0.017] and National Institutes of Health Stroke Scale [OR(95%CI);1.230(1.085, 1.395),P = 0.001(per unit increase)] emerged as the independent predictors of poor outcome (modified Rankin Scale >2) when adjusted for other imaging predictors of outcome.
  
  
  CONCLUSIONS
  CRISP grading was precise in predicting stroke outcomes when compared to individual imaging scales including arterial collateral grading, PRECISE score and CTA-SI ASPECTS in patients with proximal arterial occlusion in the anterior circulation.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta.
authors.forename: Rajsrinivas
authors.initials: R
authors.lastname: Parthasarathy
authors.affiliation: Department of Neurology, Institute for Brain Research, Keimyung University School of Medicine, Daegu, South Korea.
authors.forename: Sung-Il
authors.initials: SI
authors.lastname: Sohn
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jeerakathil
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta.
authors.forename: Mahesh P
authors.initials: MP
authors.lastname: Kate
authors.affiliation: Department of Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta.
authors.forename: Sachin M
authors.initials: SM
authors.lastname: Mishra
authors.affiliation: Department of Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta.
authors.forename: Vivek K
authors.initials: VK
authors.lastname: Nambiar
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta.
authors.forename: Aftab
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Department of Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta.
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Menon
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta.
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D059906:Neuroimaging / Q000379:methods*; D011379:Prognosis; D020521:Stroke / Q000000981:diagnostic imaging*
keywords: CT angiography; Cerebral veins; acute ischemic stroke; cerebral perfusion; collaterals; imaging; prognosis