Application of collateral circulation scoring based on CTA in acute ischemic stroke with large vessel occlusion
Objective This study aimed to investigate the inter-rater reliability and assessment validity of four collateral circulation scoring systems based on CTA:Miteff score(distal collateral branch score for middle cerebral artery occlusion),Maas score for lateral fissure,cerebral convexity collateral branch,Tan score for regional collateral branch of middle cerebral artery,and regional leptomeningeal collateral score(rLMC score).Additionally,it aimed to explore the predictive value for the prognosis of mechanical thrombectomy in patients with acute ischemic stroke with large vessel occlusion(AIS-LVO)and investigate the independent prognostic factors,thereby aiding in the clinical assessment of collateral circulation and selection of treatment strategies.Methods A retrospective analysis was conducted on clinical and imaging data of 98 patients with AIS-LVO treated by the Affiliated Hospital of Hebei University from September 2020 to September 2023.The inter-rater reliability of four scoring systems was explored based on the assessments of two physicians using Miteff score,Mass score,Tan score,and rLMC score.With the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR)grading system based on digital subtraction angiography(DSA)as reference,the validity of these four scores in evaluating collateral circulation was investigated.Univariate and multivariate binary logistic regression analyses were employed to identify independent prognostic factors for AIS-LVO patients.Furthermore,the predictive value of different scores for patient prognosis was compared through ROC curve analysis.Results In terms of inter-rater reliability of the four CTA-based collateral circulation scores,rLMC score ranked the first,followed by Miteff score,Tan score,and Maas score successively(Kappa=0.810,0.797,0.745,0.733,respectively;all P＜0.05),and the result was the same in terms of the validity of assessment(rs=0.687,0.534,0.481,0.423,respectively;all P＜0.05).The blood glucose(OR=0.438,95％CI:0.196-0.975)and the National Institutes of Health Stroke Scale(NIHSS)score(OR=0.837,95％CI:0.699-1.002)on admission were independent prognostic factors for AIS-LVO patients(both P＜0.05).The good collateral circulation assessed by Miteff score(OR=0.055,95％CI:0.007-0.461),Maas score(OR=0.047,95％CI:0.006-0.391),Tan score(OR=0.122,95％CI:0.020-0.721),and rLMC score(OR=0.080,95％CI:0.014-0.460)were independent prognostic factors for AIS-LVO patients(all P＜0.05).ROC curve analysis revealed that rLMC score showed the highest predictive value for patient prognosis,followed by Miteff score,Tan score,and Maas score successively(AUC=0.812,0.773,0.720,0.705,respectively;all P＜0.05),with the optimal cutoff values of 10.5,2.5,1.5,and 2.5 points,respectively.Conclusion The rLMC score demonstrated the highest inter-rater reliability compared to the other three scores(Miteff score,Maas score,Tan score)and the highest validity in collateral circulation assessment,which showed the highest predictive value for the prognosis of mechanical thrombectomy treatment.Patients with higher blood glucose levels or NIHSS scores on admission showed poorer prognoses following mechanical thrombectomy treatment.
万方数据
维普
