BACKGROUND: Multiphase CTA (mCTA) is an established tool for endovascular treatment decision-making and outcome prediction in acute ischemic stroke, but its interpretation requires some degree of experience. We aimed to determine whether mCTA-based prediction of clinical outcome and final infarct volume can be improved by assessing collateral status on time-variant mCTA color maps rather than using a conventional mCTA display format. METHODS: Patients from the PRove-IT cohort study with anterior circulation large vessel occlusion were included in this study. Collateral status was assessed with a three-point scale using the conventional display format. Collateral extent and filling dynamics were then graded on a three-point scale using time-variant mCTA color-maps (FastStroke, GE Healthcare, Milwaukee, WI, USA). Multivariable logistic regression was performed to determine the association of conventional collateral score, color-coded collateral extent and color-coded collateral filling dynamics with good clinical outcome and final infarct volume (volume below vs. above median infarct volume in the study sample). RESULTS: A total of 285 patients were included in the analysis and 53% (152/285) of the patients achieved a good outcome. Median infarct volume on follow-up was 12.6 ml. Color-coded collateral extent was significantly associated with good outcome (adjusted odds ratio [adjOR] 0.53, 95% confidence interval [CI]:0.36-0.77) while color-coded collateral filling dynamics (adjOR 1.30 [95%CI:0.88-1.95]) and conventional collateral scoring (adjOR 0.72 [95%C:0.48-1.08]) were not. Both color-coded collateral extent (adjOR 2.67 [95%CI:1.80-4.00]) and conventional collateral scoring (adjOR 1.84 [95%CI:1.21-2.79]) were significantly associated with follow-up infarct volume, while color-coded collateral filling dynamics were not (adjOR 1.21 [95%CI:0.83-1.78]). CONCLUSION: In this study, collateral extent assessment on time-variant mCTA maps improved prediction of good outcome and has similar value in predicting follow-up infarct volume compared to conventional mCTA collateral grading.

Czech National Centre for Evidence Based Healthcare and Knowledge Translation Faculty of Medicine Masaryk University Brno Czech Republic

Department of Clinical Neurosciences Foothills Medical Centre University of Calgary 1403 29th St NW T2N2T9 Calgary AB Canada

Department of Medical Biophysics University of Western Ontario London Canada

Department of Medical Imaging St Anne's University Hospital Brno and Faculty of Medicine Masaryk University Brno Czech Republic

Department of Radiology University Hospital of Basel Basel Switzerland

Department of Radiology University of Calgary Calgary Canada

International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic

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