Pivotal role of multiphase computed tomography angiography for collateral assessment in patients with acute ischemic stroke

The cerebral collateral circulation is the main compensatory mechanism that maintains the ischemic penumbra viable, the tissue at risk for infarction that can be saved if blood flow is restored by reperfusion therapies. In clinical practice, the extent of collateral vessels recruited after vessel oc...

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Bibliographic Details
Published in:Radiologia medica 2023-08, Vol.128 (8), p.944-959
Main Authors: Busto, Giorgio, Morotti, Andrea, Carlesi, Edoardo, Fiorenza, Alessandro, Di Pasquale, Francesca, Mancini, Sara, Lombardo, Ivano, Scola, Elisa, Gadda, Davide, Moretti, Marco, Miele, Vittorio, Fainardi, Enrico
Format: Article
Language:English
Subjects:
Angiography
Blood flow
Blood vessels
Computed Tomography
Criteria
Diagnostic Radiology
Imaging
Interventional Radiology
Medical imaging
Medicine
Medicine & Public Health
Multiphase
Neuroradiology
Occlusion
Radiology
Stroke
Tomography
Ultrasound
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Summary:The cerebral collateral circulation is the main compensatory mechanism that maintains the ischemic penumbra viable, the tissue at risk for infarction that can be saved if blood flow is restored by reperfusion therapies. In clinical practice, the extent of collateral vessels recruited after vessel occlusion can be easily assessed with computed tomography angiography (CTA) using two different techniques: single-phase CTA (sCTA) and multi-phase CTA (mCTA). Both these methodologies have demonstrated a high prognostic predictive value for prognosis due to the strong association between the presence of good collaterals and favorable radiological and clinical outcomes in patients with acute ischemic stroke (AIS). However, mCTA seems to be superior to sCTA in the evaluation of collaterals and a promising tool for identifying AIS patients who can benefit from reperfusion therapies. In particular, it has recently been proposed the use of mCTA eligibility criteria has been recently proposed for the selection of AIS patients suitable for endovascular treatment instead of the current accepted criteria based on CT perfusion. In this review, we analyzed the characteristics, advantages and disadvantages of sCTA and mCTA to better understand their fields of application and the potential of mCTA in becoming the method of choice to assess collateral extent in AIS patients.
ISSN:1826-6983
0033-8362
1826-6983
DOI:10.1007/s11547-023-01668-9