1Nagy Salah Ismail,1Ahmed Abdel Alim, 1Farouk Hassan
1Kasr Aliany, Cairo University Hospitals
Stroke is the leading cause of disabling disease and mortality worldwide (1). Patients with suspected acute ischemic stroke should be rapidly evaluated clinically and radiologically to 1) confirm diagnosis, 2) exclude common stroke mimics, 3) identify contraindications to revascularization, 4) Site of vascular occlusion (2). Treatment decision (IV thrombolysis and/or mechanical revascularization) is based on the time window and imaging features: parenchymal lesion and arterial occlusion site (3). Multimodal CT includes NCCT and CTA of head and neck CT perfusion (CTP). Multimodal MRI includes various sequences, such as DWI, ADC, FLAIR, GRE, and perfusion-weighted imaging in addition to MRA of head and neck (4). NCCT help making a decision of acute management (5). CTA is used to determine the site of arterial occlusion and qual¬ity of the collateral flow, which is an important prognos¬tic factor for good outcome (6). CTA can display collateral supply at the level of Willis’ circle arteries and the retrograde filling of the cortical arteries by leptomeningeal junctions, the development of arterial collaterals lowers the speed of infarction growth and increases the chance of a good clinical outcome with timely recanalization (7).
Reperfusion therapy including intravenous (r-tPA) and mechanical thrombectomy (MT) are the only approved treatments for AIS.
The study aimed to evaluate the relation of collateral status in CTA to the clinical outcome of acute ischemic stroke management.
Material(s) and Method(s):
This was a prospective study carried out over the span of 2 years (January 2019 to December 2020) for evaluation of the impact of the collateral status in cerebral CTA on the clinical outcome of acute ischemic stroke management.
A total number of 51 patients: 30 males and 21 females. The age of the patients ranged from 34 to 80 years, and the mean was 55.4. All patients were presented by symptoms of acute ischemic stroke and underwent CTA to assess vascular occlusion and the state of collateral circulation; some had different comorbities as discussed in (table 1)
The current prospective investigation was achieved during two years (January 2019 to December 2020) for patients with acute ischemic stroke who have done CTA of cerebral circulation for assessment of the collateral state. A total number of 51 participants: 30 males and 21 females. The age of the participants varied from 34 to 80 years (mean 55.4). Every participant was clinically evaluated, subjected to NCCT followed by CT cerebral angiography to assess large vessel occlusion, state of collateral circulation according to Tan scale (0 –3): 0 (absent collaterals), 1 (collateral filling 0-50%), 2 (collateral filling >50 but <100%) and 3 for 100% collateral filling compared to opposite side.
Good state of the cerebral collaterals in patients with acute ischemic stroke was associated with good clinical outcome, good reperfusion, lower rates of symptomatic ICH, mortality rate and stroke severity.