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Original research
CT perfusion and angiographic assessment of pial collateral reperfusion in acute ischemic stroke: the CAPRI study
  1. Arturo Consoli1,
  2. Tommy Andersson2,3,
  3. Ake Holmberg3,
  4. Luca Verganti4,
  5. Andrea Saletti5,
  6. Stefano Vallone4,
  7. Andrea Zini6,
  8. Alfonso Cerase7,
  9. Daniele Romano7,
  10. Sandra Bracco7,
  11. Svetlana Lorenzano8,
  12. Enrico Fainardi5,
  13. Salvatore Mangiafico1
  14. on behalf of the CAPRI Collaborative Group
    1. 1Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy
    2. 2Departments of Radiology and Neurology, AZ Groeninge, Kortrijk, Belgium
    3. 3Department of Neuroradiology, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    4. 4Department of Neuroradiology, Nuovo Ospedale Civile ‘S Agostino-Estense’, Modena, Italy
    5. 5Neuroradiology Unit, Azienda Ospedaliero-Universitaria of Ferrara, Cona, Ferrara, Italy
    6. 6Stroke Unit, Department of Neuroscience, Nuovo Ospedale Civile ‘S Agostino-Estense’, Modena, Italy
    7. 7Unit of Neuroimaging and Neurointervention, Policlinico ‘Santa Maria alle Scotte,’, Siena, Italy
    8. 8Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
    1. Correspondence to Dr A Consoli, Interventional Neuroradiology Unit, Careggi University Hospital, Largo Palagi 1, 4th floor CTO, Firenze 50134, Italy; onemed21{at}


    Background The purpose of this study was to evaluate the correlation between a novel angiographic score for collaterals and CT perfusion (CTP) parameters in patients undergoing endovascular treatment for acute ischemic stroke (AIS).

    Methods 103 patients (mean age 66.7±12.7; 48.5% men) with AIS in the anterior circulation territory, imaged with non-contrast CT, CT angiography, and CTP, admitted within 8 h from symptom onset and treated with any endovascular approach, were retrospectively included in the study. Clinical, neuroradiological data, and all time intervals were collected. Careggi Collateral Score (CCS) was used for angiographic assessment of collaterals and the Alberta Stroke Program Early CT Score (ASPECTS) for semiquantitative analysis of CTP maps. Two centralized core laboratories separately reviewed angiographic data, whereas CT findings were evaluated by an expert neuroradiologist. Univariate and multivariate analysis were performed considering CCS both as an ordinal and a dichotomous variable.

    Results 37/103 patients (35.9%) received intravenous tissue plasminogen activator. Median (IQR) ASPECTS was 9 (6–10) for admission CT, 9 (5–10) for cerebral blood volume (CBV) maps, 3 (2–3) for mean transit time maps, 3 (2–4), for cerebral blood flow maps, and 5 (3–7) for CTP mismatch. Univariate analysis showed a significant correlation between CCS and ASPECTS for all CTP parameters. Multivariate analysis confirmed an independent association only between CCS and CBV (p=0.020 when CCS was considered as a dichotomous variable, p=0.026 with ordinal CCS).

    Conclusions A correlation between angiographic assessment of the collateral circulation and CTP seems to be present, suggesting that CCS may provide an indirect evaluation of the infarct core volume to consider for patient selection in AIS.

    • Stroke
    • Angiography
    • CT perfusion

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    • Collaborators Andrea Rosi, Leonardo Renieri, Sergio Nappini, Nicola Limbucci, Guido Bigliardi, Maria Luisa Dell’Acqua, Onofrio Marcello, Luca Borgatti, Massimo Borrelli, Stefano Ceruti, Andrea Bernardoni, Marina Padroni, Carmine Tamborino, Alessandro De Vito, Cristiano Azzini, and Leonardo Capaccioli.

    • Contributors ACo and SM were responsible for the concepts of the study, coordinated the study group, and drafted and reviewed the different versions of the paper. EF, TA, and SM were involved in the core laboratories for CT and angiographic images. SL performed the statistical analysis. EF, TA, AH, AS, LV, SV, ACe, SB, DR, AZ, and all the collaborators of the CAPRI Collaborative Group, collected the cases and reviewed all versions of the drafted papers.

    • Competing interests None declared.

    • Ethics approval The study was approved by the local institutional review board of each participating center.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All supplementary data, including specifications about the study protocol and further analyses, have been submitted and are available as supplementary material.