. 2022 Feb;269(2):1013-1023.

doi: 10.1007/s00415-021-10898-8. Epub 2021 Nov 19.

Association of the Careggi Collateral Score with 3-month modified Rankin Scale score after thrombectomy for stroke with occlusion of the middle cerebral artery

Manuel Cappellari¹, Valentina Saia², Giovanni Pracucci³, Fainardi Enrico⁴, Arturo Consoli^{5

6}, Sergio Nappini⁶, Lucio Castellan⁷, Sandra Bracco⁸, Mauro Bergui⁹, Mirco Cosottini¹⁰, Alessandra Briatico Vangosa¹¹, Sergio Vinci¹², Maria Ruggiero¹³, Edoardo Puglielli¹⁴, Luigi Chiumarulo¹⁵, Giacomo Cester¹⁶, Chiara Comelli¹⁷, Umberto Silvagni¹⁸, Daniele Morosetti¹⁹, Valentina Caldiera²⁰, Nicola Cavasin²¹, Valeria Ledda²², Giuseppina Sanfilippo²³, Andrea Saletti²⁴, Pietro Filauri²⁵, Ivan Gallesio²⁶, Nunzio Paolo Nuzzi²⁷, Pitero Amistá²⁸, Cecilia Zivelonghi²⁹, Mauro Plebani³⁰, Marco Pavia³¹, Daniele Romano³², Francesco Biraschi³³, Roberto Menozzi³⁴, Roberto Gasparotti³⁵, Andrea Giorgianni³⁶, Andrea Zini³⁷, Domenico Inzitari³, Danilo Toni^#³⁸, Salvatore Mangiafico^#⁶; IRETAS Group

Affiliations

¹ Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy. manuel_cappellari@libero.it.
² Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy.
³ Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy.
⁴ Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy.
⁵ Service de Neuroradiologie Diagnostique et Thérapeutique Hôpital Foch, Suresnes, France.
⁶ Interventional Neurovascular Unit, Careggi University Hospital, Florence, Italy.
⁷ Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁸ Unit of Neuroimaging and Neurointervention, University Hospital of Siena, Siena, Italy.
⁹ Interventional Neuroradiology Unit, Città della Salute e della Scienza-Molinette, Turin, Italy.
¹⁰ Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
¹¹ Diagnostic and Interventional Neuroradiology Unit-"SS. Annunziata" Hospital, Taranto, Italy.
¹² UOC Neuroradiology, Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy.
¹³ Department of Neuroradiology, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy.
¹⁴ Vascular and Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy.
¹⁵ UOS Neuroradiologia Interventistica, AOU Consorziale Policlinico, Bari, Italy.
¹⁶ Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy.
¹⁷ Interventional Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy.
¹⁸ Interventional Neuroradiology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy.
¹⁹ Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy.
²⁰ Department of Neuroradiology, S. Corona Hospital, Pietra Ligure, Italy.
²¹ Neuroradiology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy.
²² Vascular and Interventional Neuroradiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy.
²³ Radiologia e Neuroradiologia Diagnostica e Interventistica, IRCCS Policlinico San Matteo, Pavia, Italy.
²⁴ Interventional Neuroradiology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy.
²⁵ Neuroradiology Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy.
²⁶ Neuroradiological Unit, Department of Radiology, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy.
²⁷ Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy.
²⁸ Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy.
²⁹ Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
³⁰ Neuroradiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
³¹ Neuroradiology Unit, Fondazione Poliambulanza, Brescia, Italy.
³² UOC Neuroradiologia, AUO S. Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.
³³ Department of Human Neurosciences, Interventional Neuroradiology, Università degli Studi di Roma Sapienza, Rome, Italy.
³⁴ Neuroradiology Unit, Ospedale Universitario, Parma, Italy.
³⁵ Neuroradiology Unit, Spedali Civili, Brescia, Italy.
³⁶ Neuroradiology Department, Ospedale di Circolo-ASST Sette Laghi, Varese, Italy.
³⁷ Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy.
³⁸ Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.

^# Contributed equally.

PMID: 34797435
DOI: 10.1007/s00415-021-10898-8

Association of the Careggi Collateral Score with 3-month modified Rankin Scale score after thrombectomy for stroke with occlusion of the middle cerebral artery

Manuel Cappellari et al. J Neurol. 2022 Feb.

. 2022 Feb;269(2):1013-1023.

doi: 10.1007/s00415-021-10898-8. Epub 2021 Nov 19.

Authors

Affiliations

¹ Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy. manuel_cappellari@libero.it.
² Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy.
³ Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy.
⁴ Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy.
⁵ Service de Neuroradiologie Diagnostique et Thérapeutique Hôpital Foch, Suresnes, France.
⁶ Interventional Neurovascular Unit, Careggi University Hospital, Florence, Italy.
⁷ Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁸ Unit of Neuroimaging and Neurointervention, University Hospital of Siena, Siena, Italy.
⁹ Interventional Neuroradiology Unit, Città della Salute e della Scienza-Molinette, Turin, Italy.
¹⁰ Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
¹¹ Diagnostic and Interventional Neuroradiology Unit-"SS. Annunziata" Hospital, Taranto, Italy.
¹² UOC Neuroradiology, Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy.
¹³ Department of Neuroradiology, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy.
¹⁴ Vascular and Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy.
¹⁵ UOS Neuroradiologia Interventistica, AOU Consorziale Policlinico, Bari, Italy.
¹⁶ Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy.
¹⁷ Interventional Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy.
¹⁸ Interventional Neuroradiology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy.
¹⁹ Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy.
²⁰ Department of Neuroradiology, S. Corona Hospital, Pietra Ligure, Italy.
²¹ Neuroradiology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy.
²² Vascular and Interventional Neuroradiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy.
²³ Radiologia e Neuroradiologia Diagnostica e Interventistica, IRCCS Policlinico San Matteo, Pavia, Italy.
²⁴ Interventional Neuroradiology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy.
²⁵ Neuroradiology Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy.
²⁶ Neuroradiological Unit, Department of Radiology, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy.
²⁷ Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy.
²⁸ Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy.
²⁹ Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
³⁰ Neuroradiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
³¹ Neuroradiology Unit, Fondazione Poliambulanza, Brescia, Italy.
³² UOC Neuroradiologia, AUO S. Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.
³³ Department of Human Neurosciences, Interventional Neuroradiology, Università degli Studi di Roma Sapienza, Rome, Italy.
³⁴ Neuroradiology Unit, Ospedale Universitario, Parma, Italy.
³⁵ Neuroradiology Unit, Spedali Civili, Brescia, Italy.
³⁶ Neuroradiology Department, Ospedale di Circolo-ASST Sette Laghi, Varese, Italy.
³⁷ Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy.
³⁸ Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.

^# Contributed equally.

PMID: 34797435
DOI: 10.1007/s00415-021-10898-8

Erratum in

Correction to: Association of the Careggi Collateral Score with 3-month modified Rankin Scale score after thrombectomy for stroke with occlusion of the middle cerebral artery.
Cappellari M, Saia V, Pracucci G, Fainardi E, Consoli A, Nappini S, Castellan L, Bracco S, Bergui M, Cosottini M, Vangosa AB, Vinci S, Ruggiero M, Puglielli E, Chiumarulo L, Cester G, Comelli C, Silvagni U, Morosetti D, Caldiera V, Cavasin N, Ledda V, Sanfilippo G, Saletti A, Filauri P, Gallesio I, Nuzzi NP, Amistá P, Zivelonghi C, Plebani M, Pavia M, Romano D, Biraschi F, Menozzi R, Gasparotti R, Giorgianni A, Zini A, Inzitari D, Toni D, Mangiafico S; IRETAS Group. Cappellari M, et al. J Neurol. 2022 Feb;269(2):1024-1025. doi: 10.1007/s00415-021-10941-8. J Neurol. 2022. PMID: 34951659 No abstract available.

Abstract

Background: The Careggi Collateral Score (CCS) (qualitative-quantitative evaluation) was developed from a single-centre cohort as an angiographic score to describe both the extension and effectiveness of the pial collateral circulation in stroke patients with occlusion of the anterior circulation. We aimed to examine the association between CCS (quantitative evaluation) and 3-month modified Rankin Scale (mRS) score in a large multi-center cohort of patients receiving thrombectomy for stroke with occlusion of middle cerebral artery (MCA).

Methods: We conducted a study on prospectively collected data from 1284 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. According to the extension of the retrograde reperfusion in the cortical anterior cerebral artery (ACA)-MCA territories, CCS ranges from 0 (absence of retrograde filling) to 4 (visualization of collaterals until the alar segment of the MCA).

Results: Using CCS of 4 as reference, CCS grades were associated in the direction of unfavourable outcome on 3-month mRS shift (0 to 6); significant difference was found between CCS of 0 and CCS of 1 and between CCS of 3 and CCS of 4. CCS ≥ 3 was the optimal cut-off for predicting 3-month excellent outcome, while CCS ≥ 1 was the optimal cut-off for predicting 3-month survival. CCS of 0 and CCS < 3 were associated in the direction of unfavourable recanalization on TICI shift (0 to 3) compared with CCS ≥ 1 and CCS ≥ 3, respectively. Compared with CCS ≥ 3 as reference, CCS of 0 and CCS 1 to 2 were associated in the direction of unfavourable recanalization on TICI shift. There was no evidence of heterogeneity of effects of successful recanalization and procedure time ≤ 60 min on 3-month mRS shift across CCS categories.

Conclusion: The CCS could provide a future advantage for improving the prognosis in patients receiving thrombectomy for stroke with M1 or M1-M2 segment of the MCA occlusion.

Keywords: Collateral Score; Modified Rankin Scale; Stroke; Thrombectomy.

PubMed Disclaimer

Cited by

Determinants of Leptomeningeal Collateral Status in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Observational Studies.
Li K, Jiang H, Yu J, Liu Y, Zhang L, Ma B, Zhu S, Qi Y, Li S, Huang Y, Yang Y, Xia X, Wen L. Li K, et al. J Am Heart Assoc. 2024 Dec 3;13(23):e034170. doi: 10.1161/JAHA.124.034170. Epub 2024 Nov 27. J Am Heart Assoc. 2024. PMID: 39604037 Free PMC article.
Multi-phase CT-Angiography outperforms angiographic careggi collateral score and predicts functional outcome in acute ischemic stroke.
Busto G, Casetta I, Morotti A, Barra A, Maccaglia MG, Bianchi A, Moretti M, Capasso F, Toffali M, Arba F, Limbucci N, Padovani A, Fainardi E. Busto G, et al. Neurol Sci. 2025 Jan;46(1):249-256. doi: 10.1007/s10072-024-07703-5. Epub 2024 Jul 18. Neurol Sci. 2025. PMID: 39023711

References

1. Liebeskind DS (2003) Collateral circulation. Stroke 34:2279–2284 - DOI
1. Lima FO, Furie KL, Silva GS et al (2010) The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke 41:2316–2322 - DOI
1. Maas MB, Lev MH, Ay H et al (2009) Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke 40:3001–3005 - DOI
1. Menon BK, O’Brien B, Bivard A et al (2013) Assessment of leptomeningeal collaterals using dynamic CT angiography in patients with acute ischemic stroke. J Cereb Blood Flow Metab 33:365–371 - DOI
1. Menon BK, Smith EE, Modi J et al (2011) Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions. AJNR Am J Neuroradiol 32:1640–1645 - DOI

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Springer
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Association of the Careggi Collateral Score with 3-month modified Rankin Scale score after thrombectomy for stroke with occlusion of the middle cerebral artery

Affiliations

Association of the Careggi Collateral Score with 3-month modified Rankin Scale score after thrombectomy for stroke with occlusion of the middle cerebral artery

Authors

Affiliations

Erratum in

Abstract

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Erratum in

Abstract

Similar articles

Cited by

References

MeSH terms

Related information

LinkOut - more resources

Full Text Sources

Medical