Role of modified TAN score in predicting prognosis in patients with acute ischemic stroke undergoing endovascular therapy
The study aimed to evaluate the prognostic role of modified TAN collateral score in predicting functional independence in ischemic stroke patients, who underwent endovascular therapy. Identifying the group of patients, who will benefit most from arterial recanalization in patients with acute ischemi...
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| Veröffentlicht in: | Clinical neurology and neurosurgery 2021-11, Vol.210, p.106978-106978, Article 106978 |
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| creator | Baydemir, Recep Aykaç, Özlem Acar, Bilgehan Atılgan Kocabaş, Zehra Uysal Milanlioğlu, Aysel Eryildiz, Ezgi Sezer Özdemir, Atilla Özcan |
| description | The study aimed to evaluate the prognostic role of modified TAN collateral score in predicting functional independence in ischemic stroke patients, who underwent endovascular therapy.
Identifying the group of patients, who will benefit most from arterial recanalization in patients with acute ischemic stroke, is the basis of success. Collateral circulation is a physiological condition that protects the brain against ischemia and inhibits the growth of a damaged area. The presence of collaterals is a well-known determinant for functional independence. Numerous collateral scoring systems are used for this purpose. The aim of this study was to evaluate the prognostic role of modified TAN collateral score (MTCS) in predicting functional independence in patients, who received endovascular therapy.
Prospective data of 101 patients, who received endovascular therapy from the stroke team of Eskisehir Osmangazi University (ESOGÜ) between 2016 and 2017, were examined retrospectively for this purpose. Collateral assessments were performed in Computed Tomography Angiography (CTA) according to the modified TAN scoring system (< 50% refers to poor collateral status, ≥ 50% refers to good collateral status). Good clinical outcome was assessed as mRS 0–2 in the 3rd month. The TICI scoring system was used in the evaluation of recanalization. Patients treated within the first 6 h of symptom onset, patients with NCCT and contrast CTA, patients with internal carotid artery and middle cerebral artery occlusion were included in the study. Posterior system stroke was not included in the study.
Of the 101 patients, 50 (49%) had poor MTCS. Presentation and 24th hour NIHSS values of the patients with poor MTCS were higher (p:0.003). The third month mRS values were low in patients with good MTCS on admission, while these values were high in patients, who presented with poor MTCS. Mortality rates were significantly higher in the patient group with poor collateral circulation score (32–5.9%) (p:0.001). No significant differences were found in the presentation ASPECT values and (TICI 2b/3) recanalization rates of the patients. The rate of futile recanalization was significantly higher in the group with poor collateral circulation (52–8%) (p:0.0001). Presentation glucose, NIHSS, mTAN, symptom-puncture time, and good ASPECT score were found to be predictive markers for good outcome by univariate analysis. The major risk factors were determined by performing multiple logistic regression ana |
| doi_str_mv | 10.1016/j.clineuro.2021.106978 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2582815189</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0303846721005072</els_id><sourcerecordid>2582815189</sourcerecordid><originalsourceid>FETCH-LOGICAL-c396t-893bd6889a30dd841473b668d1c2f32e413fdd6070a20b52a3dfc2b798b4eee33</originalsourceid><addsrcrecordid>eNqFkctuEzEUQC1ERUPgFypLbNhM8GPisXdUFVCkqpWqsrY89p3EYcYOtqcof4_TtCzYsLJ1de7zIHRByYoSKj7tVnb0AeYUV4wwWoNCdfIVWlDZsUYoIV-jBeGEN7IV3Tl6m_OOEMK5kG_QOW_FmivWLtDhPo6A44Cn6PzgweGHy1ucbUyAfcD7BM7b4sOmfuMmxOzzU9wUD6Fk_NuXLTZ2LhXPdguTtziXFH8CnoODtInHXAguPpps59EkXLaQzP7wDp0NZszw_vldoh9fvzxcXTc3d9--X13eNJYrURqpeO-ElMpw4pxsadvxXgjpqGUDZ9BSPjgnSEcMI_2aGe4Gy_pOyb4FAM6X6OOpbl3g1wy56KlOCuNoAsQ5a7aWTNI1rY2W6MM_6C7OKdTpKqUUEYIoVilxomyKOScY9D75yaSDpkQf5eidfpGjj3L0SU5NvHguP_cTuL9pLzYq8PkEQL3Ho4eks61nttVBAlu0i_5_Pf4ANDSlZQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2599066092</pqid></control><display><type>article</type><title>Role of modified TAN score in predicting prognosis in patients with acute ischemic stroke undergoing endovascular therapy</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Baydemir, Recep ; Aykaç, Özlem ; Acar, Bilgehan Atılgan ; Kocabaş, Zehra Uysal ; Milanlioğlu, Aysel ; Eryildiz, Ezgi Sezer ; Özdemir, Atilla Özcan</creator><creatorcontrib>Baydemir, Recep ; Aykaç, Özlem ; Acar, Bilgehan Atılgan ; Kocabaş, Zehra Uysal ; Milanlioğlu, Aysel ; Eryildiz, Ezgi Sezer ; Özdemir, Atilla Özcan</creatorcontrib><description>The study aimed to evaluate the prognostic role of modified TAN collateral score in predicting functional independence in ischemic stroke patients, who underwent endovascular therapy.
Identifying the group of patients, who will benefit most from arterial recanalization in patients with acute ischemic stroke, is the basis of success. Collateral circulation is a physiological condition that protects the brain against ischemia and inhibits the growth of a damaged area. The presence of collaterals is a well-known determinant for functional independence. Numerous collateral scoring systems are used for this purpose. The aim of this study was to evaluate the prognostic role of modified TAN collateral score (MTCS) in predicting functional independence in patients, who received endovascular therapy.
Prospective data of 101 patients, who received endovascular therapy from the stroke team of Eskisehir Osmangazi University (ESOGÜ) between 2016 and 2017, were examined retrospectively for this purpose. Collateral assessments were performed in Computed Tomography Angiography (CTA) according to the modified TAN scoring system (< 50% refers to poor collateral status, ≥ 50% refers to good collateral status). Good clinical outcome was assessed as mRS 0–2 in the 3rd month. The TICI scoring system was used in the evaluation of recanalization. Patients treated within the first 6 h of symptom onset, patients with NCCT and contrast CTA, patients with internal carotid artery and middle cerebral artery occlusion were included in the study. Posterior system stroke was not included in the study.
Of the 101 patients, 50 (49%) had poor MTCS. Presentation and 24th hour NIHSS values of the patients with poor MTCS were higher (p:0.003). The third month mRS values were low in patients with good MTCS on admission, while these values were high in patients, who presented with poor MTCS. Mortality rates were significantly higher in the patient group with poor collateral circulation score (32–5.9%) (p:0.001). No significant differences were found in the presentation ASPECT values and (TICI 2b/3) recanalization rates of the patients. The rate of futile recanalization was significantly higher in the group with poor collateral circulation (52–8%) (p:0.0001). Presentation glucose, NIHSS, mTAN, symptom-puncture time, and good ASPECT score were found to be predictive markers for good outcome by univariate analysis. The major risk factors were determined by performing multiple logistic regression analysis. Presentation glucose, NIHSS, and mTAN (OR:1.013, 1.29, 0.198, respectively) were found to be strong and independent predictors for good clinical outcome. According to Multiple Binary Logistic Regression analysis Backward-ward model, Baseline NIHSS, poor collaterals and baseline glucose are found as predictors for poor outcome.
This study shows that good collateral score is associated with good clinical response, small final infarct volume, third month low mRS, low admission, and 24-hour NIHSS rates. The likelihood of having long term prognosis is 7 fold higher in patients with poor collaterals. The use of the MTCS system is recommended and supported due to its easy and rapid applicability.
•Modified TAN collateral scoring system is an easy, fast and reliable way for evaluation for endovascular stroke therapy.•Good collaterals are important parameter for good outcome.•Patintes with good collaterals have low 3rd month mRS, and low final enfarct volume.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2021.106978</identifier><identifier>PMID: 34653924</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Aged ; Angiography ; Cardiovascular system ; Carotid artery ; Cerebral Angiography ; Cerebral blood flow ; Clinical outcomes ; Computed tomography ; Computed Tomography Angiography ; Endovascular ; Endovascular Procedures ; Female ; Fibrinolytic Agents - therapeutic use ; Glucose ; Hemorrhage ; Humans ; Ischemia ; Ischemic Stroke - diagnostic imaging ; Ischemic Stroke - drug therapy ; Ischemic Stroke - therapy ; Male ; Medical imaging ; Medical prognosis ; Middle Aged ; Modified TAN collateral score ; Neurology ; Normal distribution ; Patients ; Prognosis ; Regression analysis ; Retrospective Studies ; Risk factors ; Statistical analysis ; Stroke ; Tissue Plasminogen Activator - therapeutic use ; Treatment Outcome</subject><ispartof>Clinical neurology and neurosurgery, 2021-11, Vol.210, p.106978-106978, Article 106978</ispartof><rights>2021 Elsevier B.V.</rights><rights>Copyright © 2021 Elsevier B.V. All rights reserved.</rights><rights>2021. Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-893bd6889a30dd841473b668d1c2f32e413fdd6070a20b52a3dfc2b798b4eee33</citedby><cites>FETCH-LOGICAL-c396t-893bd6889a30dd841473b668d1c2f32e413fdd6070a20b52a3dfc2b798b4eee33</cites><orcidid>0000-0001-9753-8461</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0303846721005072$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34653924$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baydemir, Recep</creatorcontrib><creatorcontrib>Aykaç, Özlem</creatorcontrib><creatorcontrib>Acar, Bilgehan Atılgan</creatorcontrib><creatorcontrib>Kocabaş, Zehra Uysal</creatorcontrib><creatorcontrib>Milanlioğlu, Aysel</creatorcontrib><creatorcontrib>Eryildiz, Ezgi Sezer</creatorcontrib><creatorcontrib>Özdemir, Atilla Özcan</creatorcontrib><title>Role of modified TAN score in predicting prognosis in patients with acute ischemic stroke undergoing endovascular therapy</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description>The study aimed to evaluate the prognostic role of modified TAN collateral score in predicting functional independence in ischemic stroke patients, who underwent endovascular therapy.
Identifying the group of patients, who will benefit most from arterial recanalization in patients with acute ischemic stroke, is the basis of success. Collateral circulation is a physiological condition that protects the brain against ischemia and inhibits the growth of a damaged area. The presence of collaterals is a well-known determinant for functional independence. Numerous collateral scoring systems are used for this purpose. The aim of this study was to evaluate the prognostic role of modified TAN collateral score (MTCS) in predicting functional independence in patients, who received endovascular therapy.
Prospective data of 101 patients, who received endovascular therapy from the stroke team of Eskisehir Osmangazi University (ESOGÜ) between 2016 and 2017, were examined retrospectively for this purpose. Collateral assessments were performed in Computed Tomography Angiography (CTA) according to the modified TAN scoring system (< 50% refers to poor collateral status, ≥ 50% refers to good collateral status). Good clinical outcome was assessed as mRS 0–2 in the 3rd month. The TICI scoring system was used in the evaluation of recanalization. Patients treated within the first 6 h of symptom onset, patients with NCCT and contrast CTA, patients with internal carotid artery and middle cerebral artery occlusion were included in the study. Posterior system stroke was not included in the study.
Of the 101 patients, 50 (49%) had poor MTCS. Presentation and 24th hour NIHSS values of the patients with poor MTCS were higher (p:0.003). The third month mRS values were low in patients with good MTCS on admission, while these values were high in patients, who presented with poor MTCS. Mortality rates were significantly higher in the patient group with poor collateral circulation score (32–5.9%) (p:0.001). No significant differences were found in the presentation ASPECT values and (TICI 2b/3) recanalization rates of the patients. The rate of futile recanalization was significantly higher in the group with poor collateral circulation (52–8%) (p:0.0001). Presentation glucose, NIHSS, mTAN, symptom-puncture time, and good ASPECT score were found to be predictive markers for good outcome by univariate analysis. The major risk factors were determined by performing multiple logistic regression analysis. Presentation glucose, NIHSS, and mTAN (OR:1.013, 1.29, 0.198, respectively) were found to be strong and independent predictors for good clinical outcome. According to Multiple Binary Logistic Regression analysis Backward-ward model, Baseline NIHSS, poor collaterals and baseline glucose are found as predictors for poor outcome.
This study shows that good collateral score is associated with good clinical response, small final infarct volume, third month low mRS, low admission, and 24-hour NIHSS rates. The likelihood of having long term prognosis is 7 fold higher in patients with poor collaterals. The use of the MTCS system is recommended and supported due to its easy and rapid applicability.
•Modified TAN collateral scoring system is an easy, fast and reliable way for evaluation for endovascular stroke therapy.•Good collaterals are important parameter for good outcome.•Patintes with good collaterals have low 3rd month mRS, and low final enfarct volume.</description><subject>Aged</subject><subject>Angiography</subject><subject>Cardiovascular system</subject><subject>Carotid artery</subject><subject>Cerebral Angiography</subject><subject>Cerebral blood flow</subject><subject>Clinical outcomes</subject><subject>Computed tomography</subject><subject>Computed Tomography Angiography</subject><subject>Endovascular</subject><subject>Endovascular Procedures</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Glucose</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Ischemic Stroke - diagnostic imaging</subject><subject>Ischemic Stroke - drug therapy</subject><subject>Ischemic Stroke - therapy</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Modified TAN collateral score</subject><subject>Neurology</subject><subject>Normal distribution</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Statistical analysis</subject><subject>Stroke</subject><subject>Tissue Plasminogen Activator - 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therapeutic use</topic><topic>Glucose</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Ischemic Stroke - diagnostic imaging</topic><topic>Ischemic Stroke - drug therapy</topic><topic>Ischemic Stroke - therapy</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Modified TAN collateral score</topic><topic>Neurology</topic><topic>Normal distribution</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Statistical analysis</topic><topic>Stroke</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baydemir, Recep</creatorcontrib><creatorcontrib>Aykaç, Özlem</creatorcontrib><creatorcontrib>Acar, Bilgehan Atılgan</creatorcontrib><creatorcontrib>Kocabaş, Zehra Uysal</creatorcontrib><creatorcontrib>Milanlioğlu, Aysel</creatorcontrib><creatorcontrib>Eryildiz, Ezgi Sezer</creatorcontrib><creatorcontrib>Özdemir, Atilla Özcan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neurology and neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baydemir, Recep</au><au>Aykaç, Özlem</au><au>Acar, Bilgehan Atılgan</au><au>Kocabaş, Zehra Uysal</au><au>Milanlioğlu, Aysel</au><au>Eryildiz, Ezgi Sezer</au><au>Özdemir, Atilla Özcan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of modified TAN score in predicting prognosis in patients with acute ischemic stroke undergoing endovascular therapy</atitle><jtitle>Clinical neurology and neurosurgery</jtitle><addtitle>Clin Neurol Neurosurg</addtitle><date>2021-11</date><risdate>2021</risdate><volume>210</volume><spage>106978</spage><epage>106978</epage><pages>106978-106978</pages><artnum>106978</artnum><issn>0303-8467</issn><eissn>1872-6968</eissn><abstract>The study aimed to evaluate the prognostic role of modified TAN collateral score in predicting functional independence in ischemic stroke patients, who underwent endovascular therapy.
Identifying the group of patients, who will benefit most from arterial recanalization in patients with acute ischemic stroke, is the basis of success. Collateral circulation is a physiological condition that protects the brain against ischemia and inhibits the growth of a damaged area. The presence of collaterals is a well-known determinant for functional independence. Numerous collateral scoring systems are used for this purpose. The aim of this study was to evaluate the prognostic role of modified TAN collateral score (MTCS) in predicting functional independence in patients, who received endovascular therapy.
Prospective data of 101 patients, who received endovascular therapy from the stroke team of Eskisehir Osmangazi University (ESOGÜ) between 2016 and 2017, were examined retrospectively for this purpose. Collateral assessments were performed in Computed Tomography Angiography (CTA) according to the modified TAN scoring system (< 50% refers to poor collateral status, ≥ 50% refers to good collateral status). Good clinical outcome was assessed as mRS 0–2 in the 3rd month. The TICI scoring system was used in the evaluation of recanalization. Patients treated within the first 6 h of symptom onset, patients with NCCT and contrast CTA, patients with internal carotid artery and middle cerebral artery occlusion were included in the study. Posterior system stroke was not included in the study.
Of the 101 patients, 50 (49%) had poor MTCS. Presentation and 24th hour NIHSS values of the patients with poor MTCS were higher (p:0.003). The third month mRS values were low in patients with good MTCS on admission, while these values were high in patients, who presented with poor MTCS. Mortality rates were significantly higher in the patient group with poor collateral circulation score (32–5.9%) (p:0.001). No significant differences were found in the presentation ASPECT values and (TICI 2b/3) recanalization rates of the patients. The rate of futile recanalization was significantly higher in the group with poor collateral circulation (52–8%) (p:0.0001). Presentation glucose, NIHSS, mTAN, symptom-puncture time, and good ASPECT score were found to be predictive markers for good outcome by univariate analysis. The major risk factors were determined by performing multiple logistic regression analysis. Presentation glucose, NIHSS, and mTAN (OR:1.013, 1.29, 0.198, respectively) were found to be strong and independent predictors for good clinical outcome. According to Multiple Binary Logistic Regression analysis Backward-ward model, Baseline NIHSS, poor collaterals and baseline glucose are found as predictors for poor outcome.
This study shows that good collateral score is associated with good clinical response, small final infarct volume, third month low mRS, low admission, and 24-hour NIHSS rates. The likelihood of having long term prognosis is 7 fold higher in patients with poor collaterals. The use of the MTCS system is recommended and supported due to its easy and rapid applicability.
•Modified TAN collateral scoring system is an easy, fast and reliable way for evaluation for endovascular stroke therapy.•Good collaterals are important parameter for good outcome.•Patintes with good collaterals have low 3rd month mRS, and low final enfarct volume.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>34653924</pmid><doi>10.1016/j.clineuro.2021.106978</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0001-9753-8461</orcidid></addata></record> |
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| ispartof | Clinical neurology and neurosurgery, 2021-11, Vol.210, p.106978-106978, Article 106978 |
| issn | 0303-8467 1872-6968 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Angiography Cardiovascular system Carotid artery Cerebral Angiography Cerebral blood flow Clinical outcomes Computed tomography Computed Tomography Angiography Endovascular Endovascular Procedures Female Fibrinolytic Agents - therapeutic use Glucose Hemorrhage Humans Ischemia Ischemic Stroke - diagnostic imaging Ischemic Stroke - drug therapy Ischemic Stroke - therapy Male Medical imaging Medical prognosis Middle Aged Modified TAN collateral score Neurology Normal distribution Patients Prognosis Regression analysis Retrospective Studies Risk factors Statistical analysis Stroke Tissue Plasminogen Activator - therapeutic use Treatment Outcome |
| title | Role of modified TAN score in predicting prognosis in patients with acute ischemic stroke undergoing endovascular therapy |
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