Validation of Cerebral Collaterals and Clot Burden on Vascular Imaging in Acute Anterior Ischemic Stroke in Relation to Functional Outcome
Sreehari Dinesh1, Dulari Gupta2, Sankar Gorthi3
1Neurology, Bharati Vidyapeeth Medical College, 2Bharati Vidyapeeth Medical College, 3Bharati hospital
Objective:
To estimate the prevalence of good functional outcomes in acute anterior ischemic stroke subjects using CT Angiography scores of cerebral collaterals and to assess the robustness of cerebral collateral scores.
Background:
Collateral status in patients with acute ischemic stroke due to anterior circulation occlusions has become an important predictor of functional outcome of patients. This study hypothesizes that cerebral collaterals would predict the clinical outcomes of patients with acute anterior ischemic stroke. The study is designed to compare the various CT Angiography based collateral circulation scoring systems for its accuracy and its correlation with the clinical functional outcome of patients at the end of 3 months.
Design/Methods:
This is an observational analytical study of patients with acute anterior ischemic strokes who present within 48 hours of symptom onset. Cerebral collaterals were classified based on various scores to identify the best to predict functional outcomes at three months follow-ups.
Results:
206 patients with acute anterior ischemic stroke were enrolled. Distribution of age was maximum in 41-70 years with 68%, 69% being males. The mean NIHSS of patients was 8.64±6.58. Hypertension was the most common risk factor (58.3%). Alcohol and tobacco chewing were significant risk factors when associated with poor functional outcomes. mCTA and Miteff scales had the best sensitivity in predicting collateral status and functional outcomes of patients with 93% sensitivity. mCTA had an accuracy of 71.36%. MAAS scoring scale had the best specificity and least sensitivity. 74.8% cases with good cerebral collateral scores had mRS <2 and good functional outcomes at 3 months.
Conclusions:
mCTA collateral scoring was the most accurate collateral scoring scale.
Good cerebral collateral status leads to good functional outcomes.
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