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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleNeurovascular/Stroke Imaging

Association of Carotid Artery Disease with Collateralization and Infarct Growth in Patients with Acute Middle Cerebral Artery Occlusion

Resul Güney, Arne Potreck, Ulf Neuberger, Niclas Schmitt, Jan Purrucker, Markus A. Möhlenbruch, Martin Bendszus and Fatih Seker
American Journal of Neuroradiology May 2024, 45 (5) 574-580; DOI: https://doi.org/10.3174/ajnr.A8180
Resul Güney
aFrom the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
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  • ORCID record for Resul Güney
Arne Potreck
aFrom the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
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Ulf Neuberger
aFrom the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
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  • ORCID record for Ulf Neuberger
Niclas Schmitt
aFrom the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
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Jan Purrucker
bDepartments of Neurology (J.P.), Heidelberg University Hospital, Heidelberg, Germany.
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Markus A. Möhlenbruch
aFrom the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
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Martin Bendszus
aFrom the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
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Fatih Seker
aFrom the Departments of Neuroradiology (R.G., A.P., U.N., N.S., M.A.M., M.B., F.S.) Heidelberg University Hospital, Heidelberg, Germany
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Article Figures & Data

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  • FIG 1.
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    FIG 1.

    Two exemplary cases of good and poor collaterals in patients with acute right side M1 occlusion of the middle cerebral artery (A and D, dotted arrow). Patient 1 shows no ipsilateral or contralateral stenosis of the extracranial ICA (B, straight arrow) and poor intracranial collaterals, Tan score 0 (C). Patient 2 demonstrates an ipsilateral and contralateral carotid artery disease marked with an arrow (E) with good intracranial collateralization, Tan score 3 (F).

  • FIG 2.
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    FIG 2.

    Tan collateral score distribution in patients with ipsilateral and contralateral carotid artery disease.

Tables

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    • View popup
    Table 1:

    Demographics

    CharacteristicValue
    Age, mean ± SD (years)73.9 ± 12.6
    Female, n (%)404 (56.9)
    Risk factors, n (%)
     Hypertension526 (74.2)
     Diabetes161 (22.7)
     Atrial fibrillation267 (37.7)
    Time from onset to imaging, min (mean, IQR)357 (94–390)
    Baseline NIHSS, median (IQR)15 (10–20)
    Premorbid mRS, median (IQR)1 (0–2)
    Baseline ASPECTS, median (IQR)8 (7–10)
    Ipsilateral carotid stenosis grade according to NASCET, mean, median (IQR)24.0, 0 (0–38)
    Contralateral carotid stenosis grade according to NASCET, mean, median (IQR)16.3, 0 (0–30)
    Tan collateral score, n (%)
     017 (2.4)
     185 (12.0)
     2186 (26.2)
     3421 (59.4)
    • View popup
    Table 2:

    Distribution of stenosis grading (NASCET)

    Tan ScoreIpsilateral Stenosis Grade (%)Contralateral Stenosis Grade (%)
    MeanMedianIQRMeanMedianIQR
    012.800–811.300–20
    118.400–2511.300–0
    219.000–2914.700–26
    322.800–5218.300–35
    • View popup
    Table 3:

    Univariate and multivariate analysis regarding the prediction of good collaterals (Tan 3)

    Unadjusted OR (95% CI)P ValueAdjusted OR (95% CI)P Value
    Age (per year)1.0 (0.99–1.01).684
    Female0.98 (0.72–1.32).89
    Hypertension1.07 (0.76–1.52).686
    Diabetes1.08 (0.76–1.56).659
    Atrial fibrillation1.07 (0.78–1.46).692
    Premorbid mRS0.96 (0.85–1.07).437
    Ipsilateral stenosis grade (per NASCET point)1.01 (1.0–1.01)< .001*1.01 (1.0–1.01).009*
    Contralateral stenosis grade (per NASCET point)1.01 (1.0–1.01).019*1.0 (1.0–1.01).34
    • Note:—An asterisk indicates a statistically significant P value.

    • View popup
    Table 4:

    Distribution of ASPECTS and infarct growth

    Ipsilateral Stenosis Grade 0%–69%Ipsilateral Stenosis Grade 70%–100%P ValueContralateral Stenosis Grade 0%–69%Contralateral Stenosis Grade 70%–100%P Value
    Baseline ASPECTS, median (IQR)9 (7–10)8 (7–9)< .0018 (7–10)8 (7–9).077
    Follow-up ASPECTS, median (IQR)7 (4–8)6 (5–8).3777 (5–8)6 (4–8).131
    Infarct growth, median (IQR)2 (1–3)1 (0–2).0052 (1–3)1 (1–4).786
    • View popup
    Table 5:

    Univariate and multivariate analysis regarding the prediction of infarct growth

    Unadjusted OR (95% CI)P ValueAdjusted OR (95% CI)P Value
    Age (per year)1.01 (0.99–1.02).334
    Female1.04 (0.77–1.4).795
    Hypertension0.98 (0.69–1.38).895
    Diabetes1.03 (0.72–1.47).868
    Atrial fibrillation0.93 (0.69–1.27).653
    Premorbid mRS0.96 (0.86–1.07).453
    Ipsilateral stenosis grade (per NASCET point)0.99 (0.99–0.99)< .001*0.99 (0.99–1.0).004*
    Contralateral stenosis (per NASCET point)0.99 (0.99–1.00).003*1.0 (0.99–1.0).355
    Tan collateral score 30.48 (0.39–0.59)< .001*0.5 (0.4–0.62)< .001*
    • Note:—An asterisk indicates a statistically significant P value.

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American Journal of Neuroradiology: 45 (5)
American Journal of Neuroradiology
Vol. 45, Issue 5
1 May 2024
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Carotid Artery Disease and Collaterals in Stroke
Resul Güney, Arne Potreck, Ulf Neuberger, Niclas Schmitt, Jan Purrucker, Markus A. Möhlenbruch, Martin Bendszus, Fatih Seker
American Journal of Neuroradiology May 2024, 45 (5) 574-580; DOI: 10.3174/ajnr.A8180
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Resul Güney, Arne Potreck, Ulf Neuberger, Niclas Schmitt, Jan Purrucker, Markus A. Möhlenbruch, Martin Bendszus, Fatih Seker
Association of Carotid Artery Disease with Collateralization and Infarct Growth in Patients with Acute Middle Cerebral Artery Occlusion
American Journal of Neuroradiology May 2024, 45 (5) 574-580; DOI: 10.3174/ajnr.A8180

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