title: Impact of Collateral Status Evaluated by Dynamic Computed Tomographic Angiography on Clinical Outcome in Patients With Ischemic Stroke.
abstract: OBJECTIVE
  Status of collateral circulation is a strong predictor of outcome after acute ischemic stroke. Our aim was to compare the predictive value of strategies for collateral blood flow assessment with dynamic computed tomographic angiography (CTA) and conventional single-phase CT angiography.
  
  
  METHODS
  Patients with a proximal middle cerebral artery occlusion underwent noncontrast CT, single-phase CTA and whole brain CT perfusion/dynamic CTA within 9 hours after stroke onset. We defined poor outcome as a score on the modified Rankin Scale score of ≥3. The association between collateral score and clinical outcome at 3 months was analyzed with Poisson regression. The prognostic value of collateral scoring with dynamic CTA and single-phase CTA in addition to age, stroke severity, and noncontrast CT was assessed with logistic regression and summarized with the area under the curve.
  
  
  RESULTS
  Seventy patients were included, with a mean age of 68 years. We observed an increased risk of poor outcome in patients with poor collaterals on single-phase CTA (risk ratio, 1.8; 95% confidence interval, 1.0-3.1) and on dynamic CTA (risk ratio, 2.0; 95% confidence interval, 1.5-2.7). The prediction of poor clinical outcome by means of collateral adjustment was better with dynamic CTA (area under the curve, 0.84; likelihood ratio test P<0.01) than by single-phase CTA (area under the curve, 0.80; likelihood ratio test P=0.33).
  
  
  CONCLUSIONS
  Collateral assessment with dynamic CTA better predicts clinical outcome at 3 months than single-phase conventional CTA.
  
  
  BACKGROUND
  URL: http://www.trialregister.nl/trialreg. Unique identifier: NTR1804. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00880113.
authors.affiliation: From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.). wijngaardido@gmail.com.
authors.forename: Ido R
authors.initials: IR
authors.lastname: van den Wijngaard
authors.affiliation: From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.).
authors.forename: Jelis
authors.initials: J
authors.lastname: Boiten
authors.affiliation: From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.).
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Holswilder
authors.affiliation: From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.).
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.affiliation: From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.).
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
authors.affiliation: From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.).
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
authors.affiliation: From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.).
authors.forename: Marieke J H
authors.initials: MJ
authors.lastname: Wermer
authors.affiliation: From the Departments of Radiology (I.v.d.W., G.H., M.v.W.), Clinical Epidemiology (A.A.), and Neurology (M.J.H.W.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, The Netherlands; and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.).
authors.forename: Marianne A A
authors.initials: MA
authors.lastname: van Walderveen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D002533:Cerebral Angiography / Q000379:methods / Q000592:standards*; D003097:Collateral Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome
keywords: angiography; four-dimensional computed tomography; risk; stroke