Article Figures & Data
Figures
- Fig 1.
This diagram depicts the scoring of the anatomic extent of pial collateral formation from the ACA territory to the MCA territory during occlusion of the M1 segment. Scoring corresponds to angiographically visible retrograde opacification of the MCA segments on the delayed venous phase.9 Each distinctly textured segment depicts the furthest extent of retrograde opacification identified on cerebral angiography for each pial collateral score.
- Fig 2.
Bar graph displays the rates of any hemorrhage (black) and significant hemorrhage (hemorrhage volume >25 mL, gray) based on the pial collateral score.
- Fig 3.
Large hemorrhagic conversion following reperfusion in a patient with distal left internal carotid occlusion with poor pial collateral formation. A, Left internal carotid arteriogram demonstrates a distal carotid internal occlusion (arrow) with refluxed contrast filling of the occipital artery (arrowhead, A). B–E, Arteriograms of the right internal carotid (B and C) and left vertebral arteries (D and E) demonstrate no circle of Willis collaterals on either the late arterial phase (arrowheads, B and D) or the late venous phase (arrowheads, C and E). Poor pial collateral formation reconstitutes, at best, the M4 branches of the MCA (arrowheads, D and E). F and G, Twenty-four hours following reperfusion (F), the patient experienced a large hemorrhage (G) and subsequently died.
- Fig 4.
Arterial (A), parenchymal (B), and late venous (C) phase arteriograms in a patient with right MCA occlusion (A, arrow) demonstrate good pial collateral formation (B and C, arrowheads) with reconstitution of the entire MCA territory, including the M1 segment (arrow, C). D and E, Following reperfusion (D), the patient had no hemorrhage or infarction (E).
Tables
Predictor OR (95% CI) Estimate (SE) P > χ2* Poor pial collateral score 3.03 (1.09–8.71) 1.11 (0.52) .0342 Platelets <200K† 2.95 (1.06–8.57) 1.08 (0.53) .0403 Diabetes 4.82 (1.49–16.9) 0.787 (0.306) .0100 Time to treat >180 min 12.0 (1.77–253) 2.47 (1.17) .0333 Intercept −0.81 (0.52) .1138 Note:—OR indicates odds ratio.
* Variables tested with P > .05 were rejected using backward selection (whole-model test, P < .0001; r2 = 0.202).
† 200K = 200,000/μL.
Predictive factor OR (95% CI) Estimate (SE) P > χ2* Poor pial collateral score 13.1 (2.84–96.0) 2.57 (0.860) .0028 Platelets <200K 8.14 (1.73–60.3) 2.10 (0.868) .0157 Intercept 0.190 (0.520) .715 Note:—OR indicates odds ratio; CI, confidence interval.
* Variables tested with P > .05 were rejected using backward selection (whole-model test, P < .0001; r2 = 0.202).
Parameter Rate of Any Hemorrhage P Value (Pearson) Rate of Significant Hemorrhage P Value (Pearson) Total 26/104 (25.0%) 10/104 (9.61%) Good collaterals 13/72 (18.1%) .0142 2/72 (2.78%) .0004 Poor collaterals 13/32 (40.6%) 8/32 (25.0%) Platelets <200K 16/42 (38.1%) .0111 8/42 (19.0%) .0072 Platelets >200K 10/62 (16.1%) 2/62 (3.23 %) * Shows significantly higher rates of any hemorrhage and significant hemorrhage (volume > 25 mL) among patients with poor pial collaterals and platelet levels <200,000/μL.
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