{
  "abstract": "Background Collateral circulation influences clinical outcomes in patients with acute ischemic stroke due to anterior circulation large-vessel occlusion (LVO). While both arterial and venous collateral assessments on single-phase computed tomography angiography (CTA) have prognostic value, they have traditionally been evaluated independently.Purpose We developed the CTA Collateral Impairment Score (CCIS), a composite measure incorporating arterial (Tan) and venous (Cortical Venous Opacification Score (COVES)) scores, and investigated its association with 90-day functional outcomes.Materials and methods We conducted a retrospective cohort study including 1080 patients with anterior circulation LVO stroke across four comprehensive stroke centers. Patients were assigned a CCIS of 0 (preserved), 1 (moderate impairment), or 2 (severe impairment) based on predefined thresholds for Tan and COVES scores.Results Favorable outcomes (modified Rankin Scale (mRS) score 0–2) occurred in 66% of patients with CCIS 0, 32% with CCIS 1, and 17% with CCIS 2 (P<0.001). Mortality increased with higher CCIS (11%, 25%, and 36% for CCIS 0, 1, and 2 respectively; P<0.001). In multivariable models, CCIS 0 and 1 were independently associated with greater odds of favorable outcomes compared with CCIS 2 (adjusted odds ratio (aOR) 5.77 (95% confidence interval (CI), 3.78 to 8.82) and 1.72 (95% CI, 1.14 to 2.60), respectively). CCIS also predicted mortality (aOR for CCIS 0 vs 2: 0.39 (95% CI, 0.25 to 0.61); P<0.001). The predictive performance of CCIS (area under the curve (AUC) 0.73) exceeded that of the Alberta Stroke Program Early CT Score (ASPECTS) and occlusion site and approximated National Institutes of Health Stroke Scale (NIHSS); inclusion of CCIS improved multivariable model discrimination (AUC 0.84).Conclusion CCIS, a composite arterial and venous collateral score derived from single-phase CTA, was strongly and independently associated with 90-day outcomes in anterior circulation LVO stroke. Its integration into acute stroke imaging assessment may improve risk stratification and guide therapeutic decisions.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuroradiology, MD Anderson Medical Center, Houston, Texas, USA",
        "Department of Radiology, Division of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Hamza Adel Salim"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USA",
        "Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA"
      ],
      "name": "Dhairya A Lakhani"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Janet Mei"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Manisha Koneru"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USA",
        "Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA"
      ],
      "name": "Aneri Balar"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Meisam Hoseinyazdi"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Shyam Majmundar"
    },
    {
      "affiliations": [
        "Department of Radiology, Brown University, Providence, Rhode Island, USA"
      ],
      "name": "Dylan Wolman"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Risheng Xu"
    },
    {
      "affiliations": [
        "Department of Neurology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Victor Urrutia"
    },
    {
      "affiliations": [
        "Department of Neurology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Elisabeth B Marsh"
    },
    {
      "affiliations": [
        "Departments of Radiology & Neurology, Boston Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Thanh N Nguyen"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Judy Huang"
    },
    {
      "affiliations": [
        "UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA"
      ],
      "name": "David S Liebeskind"
    },
    {
      "affiliations": [
        "Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA"
      ],
      "name": "Achala Vagal"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Boston, Massachusetts, USA",
        "Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Nuffield Departments of Clinical Neurosciences and Surgical Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Adam A Dmytriw"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium"
      ],
      "name": "Adrien Guenego"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA"
      ],
      "name": "Gregory W Albers"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Hanzhang Lu"
    },
    {
      "affiliations": [
        "Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA"
      ],
      "name": "Kambiz Nael"
    },
    {
      "affiliations": [
        "Department of Neurology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Argye E Hillis"
    },
    {
      "affiliations": [
        "Department of Neurology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Rafael Llinas"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, MD Anderson Medical Center, Houston, Texas, USA"
      ],
      "name": "Max Wintermark"
    },
    {
      "affiliations": [
        "Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany"
      ],
      "name": "Tobias D Faizy"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA"
      ],
      "name": "Jeremy J Heit"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Vivek Yedavalli"
    }
  ],
  "title": "Composite arterial and venous collateral score on single-phase CTA predicts 90-day outcomes in anterior circulation large-vessel occlusion stroke",
  "uid": "b0fff1c2-d42d-5cca-8afb-95b41611be97"
}