The cortical vein opacification score (COVES) is independently associated with DSA ASITN collateral score

Dhairya A Lakhani; Aneri B Balar; Subtain Ali; Musharaf Khan; Hamza Salim; Manisha Koneru; Sijin Wen; Richard Wang; Janet Mei; Argye E Hillis; Jeremy J Heit; Greg W Albers; Adam A Dmytriw; Tobias D Faizy; Max Wintermark; Kambiz Nael; Ansaar T Rai; Vivek S Yedavalli

doi:10.3174/ajnr.A8601

The cortical vein opacification score (COVES) is independently associated with DSA ASITN collateral score

AJNR Am J Neuroradiol. 2024 Nov 22:ajnr.A8601. doi: 10.3174/ajnr.A8601. Online ahead of print.

Authors

Dhairya A Lakhani¹, Aneri B Balar¹, Subtain Ali¹, Musharaf Khan¹, Hamza Salim¹, Manisha Koneru¹, Sijin Wen¹, Richard Wang¹, Janet Mei¹, Argye E Hillis¹, Jeremy J Heit¹, Greg W Albers¹, Adam A Dmytriw¹, Tobias D Faizy¹, Max Wintermark¹, Kambiz Nael¹, Ansaar T Rai¹, Vivek S Yedavalli¹

Affiliation

¹ From the Department of Radiology and Radiological Sciences (D.A.L., A.B.B., H.S., R.W., J.M., V.Y.), and Department of Neurology (A.E.H.), Johns Hopkins University, Baltimore, MD, USA; Department of Neuroradiology (D.A.L., S.A., M.K., A.T.R.), and Department of Biostatistics (S.W.), West Virginia University, Morgantown, WV, USA; Cooper Medical School of Rowan University (M.K.), Camden, NJ, USA; Department of Neurology (J.J.H., G.W.A.), Stanford University, Stanford, CA, USA; Department of Radiology (A.A.D.), Harvard Medical School, Boston, MA, USA; Department of Radiology, Neuroendovascular Division (T.D.F.), University Medical Center Münster, Germany; Department of Neuroradiology (M.W.), MD Anderson Medical Center, Houston, TX, USA; Department of Radiology (K.N.), University of California San Francisco, CA, USA.

PMID: 39578105
DOI: 10.3174/ajnr.A8601

Abstract

Background : Pretreatment CTA-based Cortical Vein Opacification Score (COVES) has been shown to predict good functional outcomes at 90 days in patients with acute ischemic stroke secondary to large vessel occlusion (AIS-LVO). This is thought to be related to its ability to measure collateral status (CS). However, its association with the reference standard test, the DSA-based American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score, has yet to be established. Therefore, this study assesses the relationship between COVES and ASITN CS.Methods : In this prospectively collected, retrospectively reviewed analysis, patients with anterior circulation LVO from September 1, 2017, to October 1, 2023, were included. The COVES grading, which ranges from 0 to 6, was independently assessed by two board-certified neuroradiologists. The ASITN CS was independently assessed by a board-certified neuroradiologist and the performing neurointerventionalist. Any discrepancies were resolved through consensus review. Spearman's rank correlation, univariable logistic regression, multivariable logistic regression, and receiver operating characteristic curve analysis were performed. A p-value of ≤0.05 was considered significant.Results : In total, 311 consecutive patients (median, IQR=68 years [59-78 years]; 55.9% female) met our inclusion criteria. There was significant positive correlation between COVES and ASITN CS (ρ=0.41,p<0.001), and higher COVES was significantly and independently associated with good ASITN CS (unadjusted-OR=1.74,p<0.001) and adjusted-OR=1.73, p<0.001). ROC analysis showed AUC of 0.71, p<0.001).Conclusion : In conclusion, by demonstrating the independent association of COVES with the reference standard test for collateral status assessment, the ASITN CS, we further validate the role of COVES in estimating collateral status.ABBREVIATIONS: AIS: Acute ischemic stroke; ASITN: American Society of Interventional and Therapeutic Neuroradiology; CS: Collateral status; COVES: Cortical Vein Opacification Score; HIR: Hypoperfusion Intensity Ratio; IVT: Intravenous thrombolysis; LVO: Large vessel occlusion; mRS: modified Rankin score; MT: mechanical thrombectomy; OR: odds ratio; aOR: adjusted odds ratio; ua: unadjusted odds ratio; rCBF: relative cerebral blood flow; Tmax: Time-to-Maximum.