Predictive Value Of The Velocity Of Collateral Filling In Patients With Acute Ischemic Stroke
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM(2015)
摘要
The velocity of collateral filling can be assessed in dynamic time-resolved computed tomography (CT) angiographies and may predict initial CT perfusion (CTP) and follow-up lesion size. We included all patients with an M1 +/- internal carotid artery (ICA) occlusion and follow-up imaging from an existing cohort of 1791 consecutive patients who underwent multimodal CT for suspected stroke. The velocity of collateral filling was quantified using the delay of time-to-peak (UP) enhancement of the M2 segment distal to the occlusion. Cerebral blood volume (CBV) and mean transit time (MU)-CBV mismatch were assessed in initial CTP. Follow-up lesion size was assessed by magnetic resonance imaging (MRI) or non-enhanced CT (NECT). Multivariate analyses were performed to adjust for extent of collateralization and type of treatment. Our study comprised 116 patients. Multivariate analysis showed a short collateral blood flow delay to be an independent predictor of a small CBV lesion (P < 0.001) and a large relative mismatch (P < 0.001) on initial CTP, of a small follow-up lesion (P < 0.001), and of a small difference between initial CBV and follow-up lesion size (P = 0.024). Other independent predictors of a small lesion on follow-up were a high morphologic collateral grade (P = 0.001), lack of an additional ICA occlusion (P = 0.009), and intravenous thrombolysis (P = 0.022). Fast filling of collaterals predicts initial CTP and follow-up lesion size and is independent of extent of collateralization.
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关键词
brain imaging,brain ischemia,cerebral blood flow measurement,imaging,neuroradiobrain ischemia
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