Comparison Of Collateral Circulation Scores By Computed Tomographic Angiography

Background and PurposeThe research shows that collateral circulation is closely related with occurrence,the progress of the disease,the choice of treatment and prognosis of acute ischemic stroke.CTA,which is a rapid and noninvasive vascular imaging technique,can clearly show the location of intracranial artery stenosis or occlusion,as well as primary and secondary collateral circulation compensation range.At present,there are many methods to evaluate collateral circulation based on CTA,but how to choose in clinical is still controversial.In this study,we compared the rLMC score,Miteff score and Tan score,which is to providing the clinical basis for the select of collateral circulation evaluation methods.MethodsPatients with acute ischemic stroke were selected from the ward of Neurology,Intensive care unit,Interventional,Neurosurgery in the first affiliated Hospital of Soochow university from August 2013 to February 2017.CTA examination showed that the middle cerebral artery M1,M2 segment or internal carotid artery occlusion;The first episode of acute ischemic stroke or previous stroke history,but left no significant neurological deficit symptoms[mRS<2 points].General information of the patients was collected.The collateral circulation of each patient and the time required to complete each score were assessed using the r LMC score,the Miteff score,and the Tan score,and were re-scored 24 hours later by the same assessor.Patients with DSA were also evaluated with ASITN/SIR scores for collateral circulation.The mRS score at 3 months was followed by 0-2 for good prognosis and 3-6 for poor prognosis.SPSS18.0 software was used for statistical processing.The Spearman correlation coefficient represents the validity,and the Kappa coefficient indicated inter rater reliability and test-retest reliability.Logistic regression analysis was used to determine the independent prognostic factors of ischemic stroke,and odds ratio(OR)and 95%confidence interval(CI)were calculated.MedCalc software was used to plot the receiver operating characteristics(ROC)curve,and the predictive value of the three scores for the prognosis of ischemic stroke was compared.P<0.05 indicates that the difference was statistically significant.Results1.In this study,115 patients were enrolled in,including 71 males(61.7%)and 44females(38.3%).The mean age of onset is(66.5±12.2)years,mean baseline NIHSS score is(11.8±6.4)points.m RS score 0-2 points in 52 cases and 3-6 points in 63 cases.Among them,56 patients underwent DSA examination.2.Miteff score spent(38.3±6.3)seconds,Tan score spent(40.9±7.6)seconds,and r LMC score spent(75.5±12.1)seconds.There were statistically significant differences among the three scores(P<0.05).3.intraobserver agreement of the three methods from highest to lowest was rLMC score(Kappa=0.871,P<0.01),Tan score(Kappa=0.842,P<0.01),Miteff score(Kappa=0.752,P<0.01).The test-retest reliability of the three methods from highest to lowest is r LMC score(Kappa=0.879,P<0.01),Tan score(Kappa=0.826,P<0.01),Miteff score(Kappa=0.775,P<0.01).4.The validity of the three methods from highest to lowest was rLMC score(r_s=0.690,P<0.05),Tan score(r_s=0.676,P<0.05),Miteff score(r_s=0.647,P<0.05).5.The results of univariable and multivariable analysis showed that the collateral circulation defined by rLMC score(OR,1.325;95%CI,1.048-1.675;P<0.05),Tan score(OR,2.938;95%CI,1.115-7.744;P<0.05)and Miteff score(OR,2.698;95%CI,1.050-6.931;P<0.05)were associated with the prognosis of acute ischemic stroke.6.The ROC curve analysis showed that the area under the curve of the rLMC score,Tan score,and Miteff score was 0.848,0.799,0.759,respectively.There was significant difference between the three scoring methods in the AUC(P<0.05),indicating the predictive value of the three to the prognosis,r LMC score>Tan score>Miteff score.Conclusion1.Compared with the Miteff score and the Tan score,the r LMC score has a high intraobserver agreement and validity,and is reliable,but complicated.2.The collateral circulation defined by the three scoring methods was associated with the prognosis of acute ischemic stroke.Compared with the Miteff score and the Tan score,the rLMC score had a higher prognostic value and was more suitable for clinical.