Abstract

An MR angiography collateral map provided patient-specific collateral perfusion information to help inform the prognosis and guide management of acute ischemic stroke through a minimal MRI protocol.

Background

Collateral circulation determines tissue fate and affects treatment result in acute ischemic stroke. A precise method for collateral estimation in an optimal imaging protocol is necessary to make an appropriate treatment decision for acute ischemic stroke.

Purpose

To verify the value of multiphase collateral imaging data sets (MR angiography collateral map) derived from dynamic contrast material–enhanced MR angiography for predicting functional outcomes after acute ischemic stroke.

Materials and Methods

This secondary analysis of an ongoing prospective observational study included data from participants with acute ischemic stroke due to occlusion or stenosis of the unilateral internal carotid artery and/or M1 segment of the middle cerebral artery who were evaluated within 8 hours of symptom onset. Data were obtained from March 2016 through August 2018. The collateral grading based on the MR angiography collateral map was estimated by using six-scale MR acute ischemic stroke collateral (MAC) scores. To identify independent predictors of favorable functional outcomes, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline diffusion-weighted imaging (DWI) lesion volume, site of steno-occlusion, collateral grade, mode of treatment, and early reperfusion were evaluated with multiple logistic regression analyses.

Results

One hundred fifty-four participants (mean age ± standard deviation, 69 years ± 13; 99 men) were evaluated. Younger age (odds ratio [OR], 0.45; 95% confidence interval [CI]: 0.29, 0.70; P < .001), lower baseline NIHSS score (OR, 0.85; 95% CI: 0.78, 0.94; P < .001), MAC score of 3 (OR, 27; 95% CI: 4.0, 179; P < .001), MAC score of 4 (OR, 17; 95% CI: 2.1, 134; P = .007), MAC score of 5 (OR, 27; 95% CI: 2.5, 306; P = .007), and successful early reperfusion (OR, 7.5; 95% CI: 2.6, 22; P < .001) were independently associated with favorable functional outcomes in multivariable analysis. There was a linear negative association between collateral perfusion grades and functional outcomes (P < .001).

Conclusion

An MR angiography collateral map was clinically reliable for collateral estimation in patients with acute ischemic stroke. This map provided patient-specific pacing information for ischemic progression.