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Comparison of Three Scores of Collateral Status for Their Association With Clinical Outcome: The HERMES Collaboration

Lookup NU author(s): Professor Phil White



This is the authors' accepted manuscript of an article that has been published in its final definitive form by American Heart Association, 2022.

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BACKGROUND: Leptomeningeal collateral status on baseline computed tomographic angiography (CTA) is associated with clinical outcome after acute ischemic stroke treatment. However, assessment of collateral status is not uniform. To compare 3 different CTA collateral scores (CS) and imaging techniques about their association with clinical outcome. METHODS: Pooled analysis of patient-level data from the Highly Effective Reperfusion Using Multiple Endovascular Devices collaboration. Patients with large vessel occlusion from 7 randomized controlled trials that compared endovascular thrombectomy with standard medical care were included. Three different CS (Tan CS, regional CS [rCS], and regional Alberta Stroke Program Early CT Score CS) and 2 imaging techniques (single-phase [sCTA] and multiphase/dynamic CTA) were evaluated. Functional independence (modified Rankin Scale score 0-2) at 3 months poststroke was the primary outcome. Furthermore, we assessed the effect of sCTA image acquisition time on collateral status assessment using an adjusted ordinal logistic regression model to obtain predicted values for the trichotomized rCS. RESULTS: Among 1147 pooled patients, 948 (82.7%) had sCTA and 199 (17.3%) multiphase/dynamic CTA as baseline angiography. With all 3 collateral scales, better CSs were associated with better 3-month functional outcome. With sCTA images, the rCS (area under the curve [AUC] 0.63) and regional Alberta Stroke Program Early CT Score CS (AUC 0.62) better predicted functional outcome than the Tan CS (AUC 0.60, respectively; P<0.001 and P=0.02). With multiphase/dynamic CTA images, all collateral scales performed similarly in predicting functional outcome (rCS [AUC 0.61]; regional Alberta Stroke Program Early CT Score CS [AUC 0.61] versus Tan CS [AUC 0.61], respectively; P=0.93 and P=0.91). Overall, no endovascular thrombectomy treatment effect modification by collateral status (rCS) was demonstrated (P=0.41). sCTA timing independently influenced CS assessment. On earlier timed sCTA, the predicted proportions of scans with poor collaterals was higher and vice versa. CONCLUSIONS: In this data set of highly selected patients with stroke, using a regional CS on sCTA likely allows for the most accurate prediction of functional outcome while on time-resolved CTA, the type of CS did not matter. Patients across all collateral grades benefit from endovascular thrombectomy. sCTA timing independently influenced CS assessment.

Publication metadata

Author(s): Gensicke H, Al-Ajlan F, Fladt J, Campbell BCV, Majoie CBLM, Bracard S, Hill MD, Muir KW, Demchuk A, San Roman L, van der Lugt A, Liebeskind DS, Brown S, White PM, Guillemin F, Davalos A, Jovin TG, Saver JL, Dippel DWJ, Goyal M, Mitchell PJ, Menon BK

Publication type: Article

Publication status: Published

Journal: Stroke

Year: 2022

Volume: 53

Issue: 12

Pages: 3548-3556

Online publication date: 17/10/2022

Acceptance date: 01/09/2022

Date deposited: 31/01/2023

ISSN (print): 0039-2499

ISSN (electronic): 1524-4628

Publisher: American Heart Association


DOI: 10.1161/STROKEAHA.122.039717

ePrints DOI: 10.57711/6hfm-y629

PubMed id: 36252099


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