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

• Published in: Stroke (1970) 2022-12, Vol.53 (12), p.3548-3556
• Main Authors: Gensicke, Henrik, Al-Ajlan, Fahad, Fladt, Joachim, Campbell, Bruce C.V., Majoie, Charles B.L.M., Bracard, Serge, Hill, Michael D., Muir, Keith W., Demchuk, Andrew, San Román, Luis, van der Lugt, Aad, Liebeskind, David S., Brown, Scott, White, Philip M., Guillemin, Francis, Dávalos, Antoni, Jovin, Tudor G., Saver, Jeffrey L., Dippel, Diederik W.J., Goyal, Mayank, Mitchell, Peter J., Menon, Bijoy K.
• Format: Article
• Language: English
• Subjects: Brain Ischemia - diagnostic imaging; Brain Ischemia - surgery; Cerebral Angiography - methods; Collateral Circulation; Computed Tomography Angiography - methods; Humans; Ischemic Stroke - diagnostic imaging; Ischemic Stroke - surgery; Retrospective Studies; Treatment Outcome
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.122.039717

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. 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. 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;