Collateral Status and Clinical Outcomes after Mechanical Thrombectomy in Patients with Anterior Circulation Occlusion

Xu, Yang; Guo, Songtao; Jiang, Hao; Hao, Han; Sun, Jian; Wu, Xi

doi:10.1155/2022/7796700

Cited by 11 publications

(6 citation statements)

References 37 publications

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“…Consistent with their hypothesis, the researchers discovered that patients who underwent endovascular therapy (EVT) for anterior circulation LVO caused by cervical large-artery atherosclerosis displayed more extensive cerebral collateral circulation and better functional outcomes at 90 days compared to those with cardioembolic stroke. However, no statistically significant differences were observed in terms of functional independence (mRS score of 0-2) or mortality between the two groups [60,61].…”

Section: Discussionmentioning

confidence: 75%

The Pathophysiology of Collateral Circulation in Acute Ischemic Stroke

et al. 2023

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Cerebral collateral circulation is a network of blood vessels which stabilizes blood flow and maintains cerebral perfusion whenever the main arteries fail to provide an adequate blood supply, as happens in ischemic stroke. These arterial networks are able to divert blood flow to hypoperfused cerebral areas. The extent of the collateral circulation determines the volume of the salvageable tissue, the so-called “penumbra”. Clinically, this is associated with greater efficacy of reperfusion therapies (thrombolysis and thrombectomy) in terms of better short- and long-term functional outcomes, lower incidence of hemorrhagic transformation and of malignant oedema, and smaller cerebral infarctions. Recent advancements in brain imaging techniques (CT and MRI) allow us to study these anastomotic networks in detail and increase the likelihood of making effective therapeutic choices. In this narrative review we will investigate the pathophysiology, the clinical aspects, and the possible diagnostic and therapeutic role of collateral circulation in acute ischemic stroke.

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Section: Discussionmentioning

confidence: 75%

The Pathophysiology of Collateral Circulation in Acute Ischemic Stroke

et al. 2023

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“…First, patients who present with a more severe stroke may have a larger and/or more invasive blood clot that is more challenging to remove, resulting in less complete recanalization of the occluded vessel(s) 30,31 . Second, higher admission NIHSS is associated with worse collateral status, 32–34 which in turn is associated with less successful reperfusion following endovascular treatment 35,36 . Third, patients with more severe stroke symptoms are more likely to already have extensive and/or irreversible ischemic brain damage than those with milder symptoms, whether due to the severity of the clot or a delay in their evaluation, limiting the amount of reperfusion that can be achieved through MT.…”

Section: Discussionmentioning

confidence: 99%

Predictors of mTICI 2c/3 over 2b in patients successfully recanalized with mechanical thrombectomy

Wang,

Huang,

Mohseni

et al. 2023

Ann Clin Transl Neurol

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ObjectiveFor patients presenting with acute ischemic stroke (AIS) caused by large vessel occlusions (LVO), mechanical thrombectomy (MT) is the treatment standard of care in eligible patients. Modified Thrombolysis in Cerebral Infarction (mTICI) grades of 2b, 2c, and 3 are all considered successful reperfusion; however, recent studies have shown achieving mTICI 2c/3 leads to better outcomes than mTICI 2b. This study aims to investigate whether any baseline preprocedural or periprocedural parameters are predictive of achieving mTICI 2c/3 in successfully recanalized LVO patients.MethodsWe conducted a retrospective multicenter cohort study of consecutive patients presenting with AIS caused by a LVO from 1 January 2017 to 1 January 2023. Baseline and procedural data were collected through chart review. Univariate and multivariate analysis were applied to determine significant predictors of mTICI 2c/3.ResultsA total of 216 patients were included in the study, with 159 (73.6%) achieving mTICI 2c/3 recanalization and 57 (26.4%) achieving mTICI 2b recanalization. We found that a higher groin puncture to first pass time (OR = 0.976, 95%CI: 0.960–0.992, p = 0.004), a higher first pass to recanalization time (OR = 0.985, 95%CI: 0.972–0.998, p = 0.029), a higher admission NIHSS (OR = 0.949, 95%CI: 0.904–0.995, p = 0.031), and a lower age (OR = 1.032, 95%CI: 1.01–1.055, p = 0.005) were associated with a decreased probability of achieving mTICI 2c/3.InterpretationA lower groin puncture to first pass time, a lower first pass to recanalization time, a lower admission NIHSS, and a higher age were independent predictors of mTICI 2c/3 recanalization.

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“…26 Xu et al reported that beter collateral status was associated with increased rate of good clinical outcome and lower mortality after MT. 27 However, these studies included AIS patients in the early time window. A recent study evaluated the effect of collaterals in AIS patients treated within and after six hours, and authors reprted that presence of good collaterals had association with better clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effect of collateral level in CT angiography on clinical prognosis in stroke patients treated with mechanical thrombectomy after six hours

Yıldırım¹,

Özdemi̇r²,

Gürkaş³

et al. 2022

NeuroAsia

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Objectives: Collaterals have an effect on the protection of penumbra tissue. We evaluated the effect of collaterals on single-phase computed tomography angiography (CTA) in patients with AIS treated with MT after 6 hours. Methods: We evaluated patients with ICA or M1 segment of MCA occlusion, time of symptom-groin puncture >6 hours, having CTA before MT, modified Treatment In Cerebral Ischemia score (mTICI) 2b-3 recanalization after MT. Data of collateral levels, outcome measures, timings and other variables were collected from Turkish Interventional Neurology Database. The level of collaterals was assessed with modified Tan scale. Results: A total of 57 patients were included in our study. The median age was 64[56.5-75] years. The median NIHSS score at onset was 15[12-17.5] points. A total of 33 (57.9%) patients had good collaterals on CTA. Hypertension (HT) and diabetes mellitus (DM) rates were increased in the poor collaterals group. NIHSS scores decreased at the 24th hour in both good and poor collaterals groups. Twenty-two (66.7%) patients in the good collaterals group and 11 (45.8%) patients in the poor collaterals group had good clinical outcomes. However, there was not a significant difference (p=0.174, OR: 2.364; 95% CI: 0.802-6.697). Mortality rates were different in both groups, but the difference was not found to be significant (5[15.2%] versus 8[33.3%], p=0.124, OR:0.357; 95% CI: 0.1-1.278). Conclusion: Good collaterals on single-phase CTA was not associated with improved neurological outcomes in AIS patients treated after 6 hours.

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Collateral Status and Clinical Outcomes after Mechanical Thrombectomy in Patients with Anterior Circulation Occlusion

Cited by 11 publications

References 37 publications

The Pathophysiology of Collateral Circulation in Acute Ischemic Stroke

The Pathophysiology of Collateral Circulation in Acute Ischemic Stroke

Predictors of mTICI 2c/3 over 2b in patients successfully recanalized with mechanical thrombectomy

Effect of collateral level in CT angiography on clinical prognosis in stroke patients treated with mechanical thrombectomy after six hours

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