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- Title
REGIONAL ANGIOGRAPHIC EVALUATION OF COLLATERAL CIRCULATION PREDICTS INFARCTION DURING ENDOVASCULAR PROCEDURES FOR MIDDLE CEREBRAL ARTERY STROKE.
- Authors
Pop, Raoul; Manisor, Monica; Beaujeux, Rémy; Marescaux, Christian; Wolff, Valérie; Simu, Mihaela
- Abstract
Backgroud and purpose. We aimed to improve patient selection by developing a regional angiographic evaluation of leptomeningeal collateral fl ow that can be used to predict infarction during stroke endovascular procedures. Matherials and methods. We evaluated all consecutive patients treated for a middle cerebral artery occlusion between 2009 and 2013. Two readers performed a zonal collateral circulation evaluation in 5 cortical regions based on the vascular anatomy. Zonal scores were correlated with the presence of infarction in the same cortical sector on pretreatment and follow-up imaging. Results. In 49 patients with 217 cortical zones we found good correlation between the degree of zonal collateral fl ow and the absence of infarction in the same zone on pretreatment imaging (receiver operator characteristic (ROC) curve of 0.74, p < 0.0001). In a subgroup of 23 recanalized patients (TICI 3) with 105 cortical zones, retrograde collateral fl ow to the proximal M4 segment predicted the absence of infarction within the same zone on follow-up imaging (positive predictive value 89,4% , negative predictive value 80%). We found good inter-rater agreement for the presence of collateral fl ow to the M4 proximal segment or further – kappa 0.77 (p = 0.05, 95%CI 0.66-0.88). The number of cortical regions with collateral fl ow to the M2 segment predicts the absence of insular infarction on follow-up imaging (ROC curve of 0,76, p = 0,001). Conclusion. Anatomic collateral fl ow evaluation can provide a real-time estimation of the size and location of irreversible ischemia during stroke endovascular procedures.
- Subjects
ANGIOGRAPHY; COLLATERAL circulation; INFARCTION; CEREBRAL arteries; STROKE; ENDOVASCULAR surgery; PERIPHERAL vascular diseases
- Publication
Romanian Journal of Neurology, 2014, Vol 13, Issue 3, p133
- ISSN
1843-8148
- Publication type
Article
- DOI
10.37897/rjn.2014.3.6