Predicting Traditional Chinese Medicine Rehabilitation in Acute Ischemic Stroke Using Multiphase CT Angiography Collateral Scores

Summary

This study examined whether multiphase CT angiography collateral scores predict the efficacy of traditional Chinese medicine rehabilitation in acute ischemic stroke recovery. The prediction model showed good initial discriminative ability, suggesting potential value for individualized therapeutic decision-making in rehabilitation practice.

Abstract

The present study evaluated the predictive value of multiphase computed tomography (CT) angiography (mCTA) collateral circulation scores in determining the efficacy of traditional Chinese medicine (TCM) rehabilitation therapy during recovery from acute ischemic stroke (AIS). Ninety-two patients treated between April 2021 and June 2023 were assigned to either combined therapy (n = 52), consisting of Western medication plus TCM rehabilitation, or conventional therapy (n = 40) with Western medication alone. Collateral circulation was assessed using Mass, Tan, and ASPECTS scores before and after a 3 month intervention. Multivariate logistic regression identified neutrophil-to-lymphocyte ratio, baseline NIHSS, and collateral scores as independent predictors of therapeutic efficacy. A significant interaction effect was observed between collateral circulation and treatment modality. The resulting prediction model demonstrated good initial discriminative ability (AUC > 0.85, 95% CI) and calibration consistency, suggesting that collateral scoring may support individualized rehabilitation strategies, though larger multicenter studies are required for validation.

Introduction

Acute ischemic stroke (AIS) is a leading cause of mortality and disability worldwide, with incidence rising in aging populations and creating substantial public health challenges^1,2. Collateral circulation plays a crucial role in maintaining perfusion in ischemic regions, limiting secondary tissue injury, and supporting recovery³. Digital subtraction angiography (DSA) is the reference standard for collateral assessment, but its invasiveness limits routine clinical use⁴. Multiphase CT angiography (mCTA) provides a less invasive, temporally resolved alternative tha....

Protocol

This study was approved by the Institutional Review Board of Southwest Medical University, and all participants provided written informed consent before enrollment (SWMU-2023-IRB-015). The protocol complied with the Declaration of Helsinki and institutional standards for human subject research. The consumables, equipment, and software used are listed in the Table of Materials.

1. Research subjects

This was a prospective observational cohort of adults in the convalescent phase of acute ischemic stroke (AIS), defined as at least 14 days and no more than 6 months after symptom onset. ....

Results

General analytic conventions
All statistical tests were two-sided, and 95% confidence intervals (CI) are reported for effect estimates and performance metrics. Where multiple comparisons were performed, false discovery rate (FDR)-adjusted q values are provided in the corresponding tables.

Cohort disposition
During the accrual window, consecutive patients meeting eligibility criteria were screened, enrolled, and followed according to the pre-specifi.......

Discussion

This study demonstrated that patients in the intervention group (acupuncture combined with Buyang Huanwu Decoction) exhibited greater improvements in collateral circulation and neurological recovery compared with the control group receiving conventional therapy (see Table 2 and Results)^11,12. Post-treatment collateral scores improved significantly in the intervention group, suggesting that Traditional Chinese Medicine (TCM) rehabilitation may be .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
64-Slice CT Scanner	CT Scanner for multiphase CT angiography	GE HealthCare	Revolution EVO 64
Electroacupuncture Device	Electroacupuncture machine used for treatment	Lhasa OMS	ITO ES-160
Iodinated Contrast Medium	Contrast medium for CT angiography	GE HealthCare	Optiray 350
mCTA Imaging Software	Post-processing software for mCTA images	Siemens Healthineers	syngo.via
Modified Buyang Huanwu Decoction	TCM decoction containing Astragalus membranaceus, Angelica sinensis, etc.	Hunan Chunkehui Traditional Chinese Medicine Co., Ltd.	CP-A069AA (Astragalus), CP-A025 (Angelica sinensis), CP-A031 (Chuanxiong), CP-A039A (Angelica sinensis), CP-H029a (Lumbricus), CP-B091a (Peach seed), CP-D004 (Safflower)
Sterile Acupuncture Needles	Disposable acupuncture needles used for treatment	Guangzhou Zhixin Chinese Herbal Medicine Co., Ltd.	Vigor Acupuncture Needle 0.20g x 40mm