title: Association Between CT Angiogram Collaterals and CT Perfusion in the Interventional Management of Stroke III Trial.
abstract: OBJECTIVE
  Collateral flow can determine ischemic core and tissue at risk. Using the Interventional Management of Stroke (IMS) III trial data, we explored the relationship between computed tomography angiogram (CTA) collateral status and CT perfusion (CTP) parameters.
  
  
  METHODS
  Baseline CTA collaterals were trichotomized as good, intermediate, and poor, and CTP studies were analyzed to quantify ischemic core, tissue at risk, and mismatch ratios. Kruskal-Wallis and Spearman tests were used to measure the strength of association and correlation between CTA collaterals and CTP parameters.
  
  
  RESULTS
  A total of 95 patients had diagnostic CTP studies in the IMS III trial. Of these, 53 patients had M1/M2 middle cerebral artery±intracranial internal carotid artery occlusion, where baseline CTA collateral grading was performed. CTA collaterals were associated with smaller CTP measured ischemic core volume (P=0.0078) and higher mismatch (P=0.0004). There was moderate negative correlation between collaterals and core (rs=-0.45; 95% confidence interval, -0.64 to -0.20) and moderate positive correlation between collaterals and mismatch (rs=0.53; 95% confidence interval, 0.29-0.71).
  
  
  CONCLUSIONS
  Better collaterals were associated with smaller ischemic core and higher mismatch in the IMS III trial. Collateral assessment and perfusion imaging identify the same biological construct about ischemic tissue sustenance.
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada. Achala.Vagal@uchealth.com.
authors.forename: Achala
authors.initials: A
authors.lastname: Vagal
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Menon
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Lydia D
authors.initials: LD
authors.lastname: Foster
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Livorine
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Yeatts
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Emmad
authors.initials: E
authors.lastname: Qazi
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: d'Esterre
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Junzi
authors.initials: J
authors.lastname: Shi
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Tomsick
authors.affiliation: From the Department of Radiology (A.V, A.L, J.S, T.T), University of Cincinnati Medical Center, OH; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F, S.Y); Department of Neurology, UCLA Medical Center (D.L); and Department of Clinical Neurosciences (A.D, M.H), Department of Radiology (B.M, E.Q, C.D, M.G, A.D., M.H.), Department of Community Health Sciences (M.H., B.M), and Department of Medicine (M.H.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis*; D002340:Carotid Artery Diseases / Q000175:diagnosis*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: carotid artery, internal; collateral circulation; perfusion imaging; stroke; tomography, x-ray computed