Clinical and Imaging Determinants of Collateral Status in Patients With Acute Ischemic Stroke in MR CLEAN Trial and Registry

Abstract

Background and Purpose— Collateral circulation status at baseline is associated with functional outcome after ischemic stroke and effect of endovascular treatment. We aimed to identify clinical and imaging determinants that are associated with collateral grade on baseline computed tomography angiography in patients with acute ischemic stroke due to an anterior circulation large vessel occlusion. Methods— Patients included in the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; n=500) and MR CLEAN Registry (n=1488) were studied. Collateral status on baseline computed tomography angiography was scored from 0 (absent) to 3 (good). Multivariable ordinal logistic regression analyses were used to test the association of selected determinants with collateral status. Results— In total, 1988 patients were analyzed. Distribution of the collateral status was as follows: absent (7%, n=123), poor (32%, n=596), moderate (39%, n=735), and good (23%, n=422). Associations for a poor collateral status in a multivariable model existed for age (adjusted common odds ratio, 0.92 per 10 years [95% CI, 0.886–0.98]), male (adjusted common odds ratio, 0.64 [95% CI, 0.53–0.76]), blood glucose level (adjusted common odds ratio, 0.97 [95% CI, 0.95–1.00]), and occlusion of the intracranial segment of the internal carotid artery with occlusion of the terminus (adjusted common odds ratio 0.50 [95% CI, 0.41–0.61]). In contrast to previous studies, we did not find an association between cardiovascular risk factors and collateral status. Conclusions— Older age, male sex, high glucose levels, and intracranial internal carotid artery with occlusion of the terminus occlusions are associated with poor computed tomography angiography collateral grades in patients with acute ischemic stroke eligible for endovascular treatment.

Clinical characteristics of fast and slow progressors of infarct growth in anterior circulation large vessel occlusion stroke

“…The latter group included patients with fast or intermediate progression of infarct growth. While earlier studies have found a possible association between cervical extracranial ICA stenosis and better collateral grade during acute ACLVO stroke, 5,11 our data does not support this contention. Patients with tandem cervical ICA occlusion and intracranial ACLVO should be emergently considered for endovascular reperfusion given otherwise dismal clinical outcomes.…”

“…Although this trend did not reach statistical significance when adjusting for other covariates, these data support earlier findings that patients with intracranial ICA occlusion are more likely to have poor collateral status and suffer worse clinical outcomes similar to fast progressors. 5,11 Slow progressors were also found to have lower rates of tandem cervical ICA occlusion relative to controls on delayed presentation. The latter group included patients with fast or intermediate progression of infarct growth.…”

“…This is consistent with a secondary analysis of pooled individual data from the MR CLEAN Trial and Registry which showed that ACLVO patients with good collaterals had a median NIHSS 15 relative to NIHSS 18 of those with poor collaterals. 11 Two recent studies also independently showed that slow progressors have lower NIHSS than fast progressors. 5,6 While these prior studies noted univariate differences of NIHSS across collateral grade and early infarct growth rate, our multivariable analysis further establishes that the magnitude of NIHSS may help differentiate slow and fast progressors on first medical contact with ACLVO patients.…”

Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study

“…1,16 At baseline, a significant difference in collateral grade was found, with a better collateral grade in younger patients. Earlier studies noted a similar relation between collateral status and higher age, 17–19 for which the pathophysiological mechanism remains to be elucidated. We found that a significantly larger proportion of young patients with stroke directly presented at an intervention center rather than a regional primary stroke center, when compared with older patients.…”

Association of Plasma Metabolic Biomarker Sphingosine-1-Phosphate With Cerebral Collateral Circulation in Acute Ischemic Stroke

“…All selected patients completed CTA examinations. We applied a previously reported Tan scoring system with a scale of 0–3 from the baseline CTA to assess the cerebral collateral circulation as follows: 0, absent collateral of the occluded vascular territory; 1, poor collateral filling (>0% but ≤ 50% of the occluded vascular territory); 2, moderate collateral filling (>50% but <100% of the occluded vascular territory); and 3, good collateral filling (100% of the occluded vascular territory) (Wiegers et al, 2020 ). Based on the collateral circulation scores, patients with AIS were categorized into the following two groups: GCC group with the Tan scores of 2–3 and PCC group with the Tan scores of 0–1.…”