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. 2005 Aug;26(7):1789-97.

Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke

Gregory A Christoforidis  1 , Yousef Mohammad, Dimitris Kehagias, Bindu Avutu, Andrew P Slivka
Affiliations

Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke

Gregory A Christoforidis et al. AJNR Am J Neuroradiol. 2005 Aug.

Abstract

Background and purpose: This study examines whether anatomic extent of pial collateral formation documented on angiography during acute thromboembolic stroke predicts clinical outcome and infarct volume following intra-arterial thrombolysis, compared with other predictive factors.

Methods: Angiograms, CT scans, and clinical information were retrospectively reviewed in 65 consecutive patients who underwent thrombolysis for acute ischemic stroke. Clinical data included age, sex, time to treatment, National Institutes of Health Stroke Scale (NIHSS) score on presentation of symptoms, NIHSS score at the time of hospital discharge, and modified Rankin scale score at time of hospital discharge. Site of occlusion, scoring of anatomic extent of pial collaterals before thrombolysis, and recanalization (complete, partial, or no recanalization) were determined on angiography. Infarct volume was measured on CT scans performed 24-48 hours after treatment.

Results: Fifty-three patients (82%) qualified for review. Both infarct volume and discharge modified Rankin scale scores were significantly lower for patients with better pial collateral scores than those with worse pial collateral scores, regardless of whether they had complete (P < .0001) or partial (P = .0095) recanalization. Adjusting for other factors, regression analysis models indicate that the infarct volume was significantly larger (P < .0001) and modified discharge Rankin scale score and discharge NIHSS score significantly higher for patients with worse pial collateral scores. Similarly, adjusting for other factors, the infarct volume was significantly lower (P = .0006) for patients with complete recanalization than patients with partial or no recanalization.

Conclusions: Evaluation of pial collateral formation before thrombolytic treatment can predict infarct volume and clinical outcome for patients with acute stroke undergoing thrombolysis independent of other predictive factors. Thrombolytic treatment appears to have a greater clinical impact in those patients with better pial collateral formation.

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Figures

F<sc>ig</sc> 1.
Fig 1.
Scoring of the anatomic extent of pial collateral blood flow from the ACA territory to the MCA territory during occlusion of the M1 segment. Scoring corresponds to the angiographically visible retrograde reconstitution of the MCA segments on the delayed venous phase. Each color is depicts the furthest extent of retrograde opacification depicted on anteroposterior cerebral angiograms for each pial collateral score.
F<sc>ig</sc> 2.
Fig 2.
Anteroposterior (A and C) and lateral (B and C) images from a left internal carotid artery angiogram obtained during the early (A and B) and delayed angiographic phases (C and D) in a patient with acute ischemic stroke due to occlusion at the M1 segment (arrow). Note the retrograde opacification of the MCA branches via pial collateral vessels extending from the ACA (arrowheads). Because there is reverse opacification of the MCA extending to the distal M1 segment, a pial collateral formation score of 1 was assigned.
See this image and copyright information in PMC

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