Impact of Collateral Filling Delay on the Development of Subacute Complications After Acute Ischemic Stroke

Abstract

Purpose

Leptomeningeal collaterals play a pivotal role in acute ischemic stroke. While most collateral scores rely on subjective visual analysis, an objective quantification is possible using dynamic computed tomography (CT) angiography (dynCTA). The aim was to determine the value of collateral filling delay (CFD) as assessed by dynCTA for predicting subacute stroke complications.

Methods

All subjects with isolated prebifurcation middle cerebral artery M1 occlusions were selected from an initial cohort of 2635 patients who underwent multiparametric CT for suspected stroke. The CFD was defined as the difference in time to peak enhancement between M2 segments of both hemispheres. Logistic regression analysis of CFD for space-occupying infarction (≥5 mm shift of brain tissue over the midline), parenchymal hematoma, and hemorrhagic transformation on follow-up imaging was performed.

Results

In this study 78 patients (47 female, median age 74 years) were included. The median CFD was 6.31 s (interquartile range [IQR] 4.00–8.64). The CFD values were correlated with qualitative collateral scores (p < 0.05). Higher CFD was associated with the development of space-occupying infarction in univariable (odds ratio, OR = 1.28; p = 0.002) and multivariable regression analysis (OR = 1.48; p = 0.004). The CFD had no association with parenchymal hematoma or hemorrhagic transformation (p > 0.05).

Conclusion

A high CFD may serve as reproducible measure for collateralization and indicate development of increased risk of space-occupying infarction.

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Correspondence to Wolfgang G. Kunz.

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Conflict of interest

M.F. Froelich, K.M. Thierfelder, L.T. Rotkopf, M.P. Fabritius, L. Kellert, S. Tiedt, W.H. Sommer, F.A. Wollenweber, F. Dorn, T. Liebig, P. Reidler and W.G. Kunz declare that they have no competing interests.

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Froelich, M.F., Thierfelder, K.M., Rotkopf, L.T. et al. Impact of Collateral Filling Delay on the Development of Subacute Complications After Acute Ischemic Stroke. Clin Neuroradiol 30, 331–337 (2020). https://doi.org/10.1007/s00062-019-00760-w

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Keywords

  • Collateralization
  • Ischemic stroke
  • Anterior circulation
  • Dynamic CT angiography
  • Malignant infarction
  • Space-occupying infarction