Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy.
J Neurol. 2022 Feb;269(2):1013-1023. doi: 10.1007/s00415-021-10898-8. Epub 2021 Nov 19.
The Careggi Collateral Score (CCS) (qualitative-quantitative evaluation) was developed from a single-centre cohort as an angiographic score to describe both the extension and effectiveness of the pial collateral circulation in stroke patients with occlusion of the anterior circulation. We aimed to examine the association between CCS (quantitative evaluation) and 3-month modified Rankin Scale (mRS) score in a large multi-center cohort of patients receiving thrombectomy for stroke with occlusion of middle cerebral artery (MCA).
We conducted a study on prospectively collected data from 1284 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. According to the extension of the retrograde reperfusion in the cortical anterior cerebral artery (ACA)-MCA territories, CCS ranges from 0 (absence of retrograde filling) to 4 (visualization of collaterals until the alar segment of the MCA).
Using CCS of 4 as reference, CCS grades were associated in the direction of unfavourable outcome on 3-month mRS shift (0 to 6); significant difference was found between CCS of 0 and CCS of 1 and between CCS of 3 and CCS of 4. CCS ≥ 3 was the optimal cut-off for predicting 3-month excellent outcome, while CCS ≥ 1 was the optimal cut-off for predicting 3-month survival. CCS of 0 and CCS < 3 were associated in the direction of unfavourable recanalization on TICI shift (0 to 3) compared with CCS ≥ 1 and CCS ≥ 3, respectively. Compared with CCS ≥ 3 as reference, CCS of 0 and CCS 1 to 2 were associated in the direction of unfavourable recanalization on TICI shift. There was no evidence of heterogeneity of effects of successful recanalization and procedure time ≤ 60 min on 3-month mRS shift across CCS categories.
The CCS could provide a future advantage for improving the prognosis in patients receiving thrombectomy for stroke with M1 or M1-M2 segment of the MCA occlusion.
卡雷吉 collateral 评分（CCS）（定性-定量评估）是从单中心队列中开发出来的一种血管造影评分，用于描述前循环闭塞性卒中患者的软脑膜侧支循环的延伸和有效性。我们旨在检查 CCS（定量评估）与接受大脑中动脉（MCA）闭塞性血管内治疗的卒中患者 3 个月改良 Rankin 量表（mRS）评分之间的关联。
我们对意大利急性卒中血管内治疗登记处前瞻性收集的数据进行了一项研究。根据皮质前大脑中动脉（ACA）-MCA 区域逆行再灌注的延伸程度，CCS 范围从 0（无逆行填充）到 4（显示侧支循环直到 MCA 的翼段）。
以 CCS 为 4 作为参考，CCS 分级与 3 个月 mRS 变化的不良预后方向相关（0 至 6）；CCS 为 0 与 CCS 为 1 之间以及 CCS 为 3 与 CCS 为 4 之间存在显著差异。CCS≥3 是预测 3 个月良好预后的最佳截断值，而 CCS≥1 是预测 3 个月生存的最佳截断值。CCS 为 0 和 CCS<3 与 TICI 分级的不良再通方向相关（0 至 3），而 CCS≥1 和 CCS≥3 则与 TICI 分级的不良再通方向相关。与 CCS≥3 作为参考相比，CCS 为 0 和 1 至 2 与 TICI 分级的不良再通方向相关。CCS 类别对成功再通和手术时间≤60 分钟对 3 个月 mRS 变化的影响没有证据表明存在异质性。
CCS 可能为接受 MCA M1 或 M1-M2 段闭塞性血管内治疗的卒中患者提供预后改善的优势。
