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London, United Kingdom 2013 9 Vascular imaging 9:50 - 10:00 Asymmetrical Internal Vein sign in acute stroke: a new marker for poor collateral circula-tion. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 185 L. Dinia1, D. Carrera2, P. Camps Renom3, R. Delgado-Mederos4, J. Martí-Fàbregas5, J.L. Munuera Del Cerro6 Stroke Unit. Department of Neurology. Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN1,Stroke Unit. Department of Neurology. Hospital de la Santa Creu i Sant Pau., Bar-celona, SPAIN2, Department of Neurology. Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN3, Stroke Unit. Department of Neurology. Hospital de la Santa Creu i Sant Pau., Barce-lona, SPAIN4, Stroke Unit. Department of Neurology. Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN5, RM Unit. Institut de Diagnòstic per la Imatge Hospital Universitari Ger-mans Tries i Pujol, Barcelona, SPAIN6 Introduction: Collateral perfusion is a strong prognostic factor and patients with good collateral circulation may respond better to reperfusion therapies. Changes in venous drainage, assessed by CT imaging, could be directly related to delayed flow in the hypoperfused territory prior to treatment. We tested the hypothesis that asymmetry in internal cerebral vein drainage correlated with col-lateral flow and severity of neurological deficit in patients with acute ischemic stroke. Methods: We evaluated clinical and radiological data of 32 consecutive patients with acute anterior cir-culation ischemic stroke within 6 hours from symptoms onset. Collateral status was graded as good or poor depending on the extent of contrast visualized distal to the occlusion on CT an-giography (CTA). Presence and asymmetry of internal vein (AIV) and arterial collateral score were blindly assessed on CTA source images (CTASI) and MIP reconstructions. Results: Median age was 73 y. Median baseline NIHSS score was 12. Mean infarct size was 115 ± 160 cm3. Asymmetrical veins were present in 37.5% of patients, in particular in proximal occlu-sions and patients with poor collaterals (91.6%). AIV was significantly associated with poor collateral status (p= 0.003) and CTASI infarct size (p=0.01). There was a trend toward a direct correlation between NIHSS and AIV (p=0.07). Presence of AIV reached high specificity (92%) and good sensitivity (61%) for poor arterial collaterals prediction (positive predictive value 91%, negative predictive value 63%). Conclusion: Presence of AIV is highly specific in detecting poor collateral circulation in acute stroke and may be a simple and fast predictor of clinical and radiological severity, possibly useful for pa-tients selection in planning reperfusion therapy strategies. 8 Vascular imaging 9:40 - 9:50 Collateral circulation on Perfusion Computed Tomography Source Images correlates with hemodynamic abnormalities in PCT maps. E. Cortijo1, A.I. Calleja2, P. García-Bermejo3, S. Pérez-Fernández4, M. Martinez5, J. Reyes6, N. Fernández-Buey7, J.F. Arenillas8 Hospital Clinico Universitario, Valladolid, SPAIN1,Hospital Clinico Universitario, Valladol-id, SPAIN2, Hospital Clinico Universitario, Valladolid, SPAIN3, Hospital Clinico Universitario, Valladolid, SPAIN4, Hospital Clinico Universitario, Valladolid, SPAIN5, Hospital Clinico Uni-versitario, Valladolid, SPAIN6, Hospital Clinico Universitario, Valladolid, SPAIN7, Hospital Clinico Universitario, Valladolid, SPAIN8 Background: Perfusion imaging has the potential to select those patients who will likely re-spond to thrombolysis. Our group has recently reported that a higher degree of leptomeningeal collateral arteries(LMC) assessed by Perfusion Computed Tomography-Source Images(PCT-SI) predicts good response to IV thrombolysis in middle cerebral artery(MCA) stroke patients. We aimed to correlate PCT-SI assessed LMC score with PCT abnormalities after quantitative calculation of perfusion maps. Methods: We prospectively studied consecutive acute MCA stroke patients treated with IV tPA who underwent PCT prior to treatment. PCT maps of time to peak(TTP), relative cerebral blood volume(rCBV), relative cerebral blood flow(rCBF), mean transit time(MTT),and time to peak of the deconvolved tissue residue function(Tmax) were automatically calculated by means of a commercially available software(Perfscape 2.0 and Neuroscape 2.0 by Olea Medical).Infarct core was defined as rCBF map<31% to the mean of contralateral side, whereas brain tissue-at-risk was defined by Tmax>6 seconds. Readers eval-uated PCT-SI in a blinded fashion to assess LMC within the hypoperfused MCA territory.LMC scored as follows:0,absence of vessels;1,collateral supply filling≤50%; 2,>50% but <100%; 3,equal or more prominent when compared to the unaffected side.The scale was divided into good(2-3) vs poor(0-1) collaterals. Results: Sixty-nine patients were included(46%women, median NIHSS 13),and 3-20-29-17 patient had LMC score of 0-1-2-3 respectively. Collaterals score was significantly associated with ratio CBF(ischemic/unaffected)(p<0.001),ratio CB-V( p<0.001) and ratio Tmax(p=0.008).Moreover, significant correlation was found between LMC score and the percentage mismatch between hypoperfused tissue(Tmax>6s volume) and infarct core(rCBF<31%)(r=0.49,p<0.001) Conclusion: the degree of LMC assessed on PCT-SI correlated well with PCT abnormalities including extent of mismatch between hypoperfused tissue and infarct core volumes.


Karger_ESC London_2013
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