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Abstract
Objective To test the hypothesis that patients with acute ischemic stroke with poorer collaterals would have faster ischemic core growth, we included 2 cohorts in the study: cohort 1 of 342 patients for derivation and cohort 2 of 414 patients for validation.
Methods Patients with acute ischemic stroke with large vessel occlusion were included. Core growth rate was calculated by the following equation: core growth rate = acute core volume on CT perfusion (CTP)/time from stroke onset to CTP. Collateral status was assessed by the ratio of severe hypoperfusion volume within the hypoperfusion region of CTP. The CTP collateral index was categorized in tertiles; for each tertile, core growth rate was summarized as median and interquartile range. Simple linear regressions were then performed to measure the predictive power of CTP collateral index in core growth rate.
Results For patients allocated to good collateral on CTP (tertile 1 of collateral index), moderate collateral (tertile 2), and poor collateral (tertile 3), the median core growth rate was 2.93 mL/h (1.10–7.94), 8.65 mL/h (4.53–18.13), and 25.41 mL/h (12.83–45.07), respectively. Increments in the collateral index by 1% resulted in an increase of core growth by 0.57 mL/h (coefficient 0.57, 95% confidence interval [0.46, 0.68], p < 0.001). The relationship of core growth and CTP collateral index was validated in cohort 2. An increment in collateral index by 1% resulted in an increase of core growth by 0.59 mL/h (coefficient 0.59 [0.48–0.71], p < 0.001) in cohort 2.
Conclusion Collateral status is a major determinant of ischemic core growth.
Glossary
- ACA=
- anterior cerebral artery;
- AUC=
- area under the receiver operating characteristic curve;
- BA=
- basilar artery;
- CBF=
- cerebral blood flow;
- CI=
- confidence interval;
- CTA=
- CT angiography;
- CTP=
- CT perfusion;
- DT=
- delay time;
- ICA=
- internal carotid artery;
- IQR=
- interquartile range;
- MCA=
- middle cerebral artery;
- mRS=
- modified Rankin Scale score;
- OR=
- odds ratio;
- PCA=
- posterior cerebral artery;
- TICI=
- Thrombolysis in Cerebral Infarction
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
INSPIRE study group coinvestigators are listed in the appendix 2 at the end of the article.
Editorial, page 41
- Received April 12, 2020.
- Accepted in final form August 12, 2020.
- © 2020 American Academy of Neurology
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