title: The Prognostic Value of a Four-Dimensional CT Angiography-Based Collateral Grading Scale for Reperfusion Therapy in Acute Ischemic Stroke Patients.
abstract: OBJECTIVE
  Leptomeningeal collaterals, which affects tissue fate, are still challenging to assess. Four-dimensional CT angiography (4D CTA) originated from CT perfusion (CTP) provides the possibility of non-invasive and time-resolved assessment of leptomeningeal collateral flow. We sought to develop a comprehensive rating system to integrate the speed and extent of collateral flow on 4D CTA, and investigate its prognostic value for reperfusion therapy in acute ischemic stroke (AIS) patients.
  
  
  METHODS
  We retrospectively studied 80 patients with M1 ± internal carotid artery (ICA) occlusion who had baseline CTP before intravenous thrombolysis. The velocity and extent of collaterals were evaluated by regional leptomeningeal collateral score on peak phase (rLMC-P) and temporally fused intensity projections (tMIP) (rLMC-M) on 4D CTA, respectively. The cutoffs of rLMC-P and rLMC-M score for predicting good outcome (mRS score ≤ 2) were integrated to develop the collateral grading scale (CGS) (rating from 0-2).
  
  
  RESULTS
  The CGS score was correlated with 3-months mRS score (non-recanalizers: ρ = -0.495, p = 0.01; recanalizers: ρ = -0.671, p < 0.001). Patients with intermediate or good collaterals (CGS score of 1 and 2) who recanalized were more likely to have good outcome than those without recanalization (p = 0.038, p = 0.018), while there was no significant difference in outcome in patients with poor collaterals (CGS score of 0) stratified by recanalization (p = 0.227).
  
  
  CONCLUSIONS
  Identification of collaterals based on CGS may help to select good responders to reperfusion therapy in patients with large artery occlusion.
authors: Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors: Sheng
authors: S
authors: Zhang
authors: Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors: Weili
authors: W
authors: Chen
authors: Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors: Huan
authors: H
authors: Tang
authors: Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors: Quan
authors: Q
authors: Han
authors: Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors: Shenqiang
authors: S
authors: Yan
authors: Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors: Xiaocheng
authors: X
authors: Zhang
authors: Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors: Qingmeng
authors: Q
authors: Chen
authors: Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors: Mark
authors: M
authors: Parsons
authors: Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors: Shaoshi
authors: S
authors: Wang
authors: Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors: Min
authors: M
authors: Lou
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications*; D000072226:Computed Tomography Angiography; D005260:Female; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D008297:Male; D011379:Prognosis; D015424:Reperfusion; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome