- •108 patients with acute ischemic stroke were evaluated by multiphase CTA.
- •Inter-rater reliability was intermediate-good. CIN was found in 3 patients (2.8%).
- •With NIHSS of ≥ 6, CTA showed severe stenosis/occlusions in 77 patients (71%).
- •47% of patients with severe stenosis/occlusion had poor collateralization.
- •The patients with poor collateral circulation had larger infarct and poorer outcomes.
Multiphase computed tomography angiography (CTA) provides information on the status of major cranial arteries and extent of brain collateralization. The purpose of the study was to determine whether implementation of multiphase CTA in routine clinical practice was feasible, safe and useful. Patients with acute ischemic stroke (NIHSS ≥ 6) were included. Multiphase CTA was performed. Duration of performing multiphase CTA, inter-rater correlation and incidence of contrast-induced nephropathy (CIN) were studied. Infarct volume, incidence of hemorrhagic transformation, the rates of favorable outcome and death were compared between those with poor and intermediate-good collateralization. Multiphase CTA was performed in 108 patients. Mean duration on each multiphase CTA study was 4.8 min. Inter-rater reliability was intermediate-good (weighted kappa 0.7569, p < 0.001). CIN occurred in 3 patients (2.8%). There were no major intracranial/extracranial artery occlusion in 31 patients (29%) and there were severe stenosis or occlusions in 77 patients (71%). In the subgroup of patients with major artery severe stenosis or occlusion, 36 patients (36/77, 47%) had poor collateralization. Despite non-significant difference in acute treatment, the patients with poor collateralization had larger infarct (123 vs 35 cc, p < 0.001) and poorer outcomes (mean modified Rankin scale 3.86 vs 2.73, p = 0.011), while the differences in symptomatic hemorrhagic transformation (2.6 vs 7%, p = 0.385) and death rate (14 vs 12%, p = 0.825) were non-significant, as compared to those with intermediate-good collateralization. Multiphase CTA was feasible and safe. Besides the status of major arteries, multiphase CTA provided information on collateralization, which was associated with the size of infarct and clinical outcomes.
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Published online: December 19, 2018
Accepted: December 10, 2018
Received: September 7, 2018
© 2018 Elsevier Ltd. All rights reserved.