Good collaterals and better outcomes after EVT for basilar artery occlusion: A systematic review and meta-analysis

Abstract

Background: Stroke caused by acute basilar artery occlusion (BAO) is devastating with high dependency and mortality. Recent trials have demonstrated the efficacy of endovascular treatment (EVT) for acute BAO, while pretreatment collaterals may be a valuable prognostic indicator for post-EVT outcomes. Aims: To systematically review and synthesize evidence on the associations between pretreatment collateral status and outcomes after EVT in acute BAO. Methods: We retrieved relevant full-text articles published in English since 1 January 2010, reporting associations between pretreatment collateral status and outcomes after EVT for BAO, by searching MEDLINE and Embase. The primary outcome was favorable or good 90-day functional outcome (modified Rankin Scale [mRS] 0-2 or 0-3); secondary outcomes included successful recanalization, symptomatic intracranial hemorrhage, final infarct volume, and 90-day mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) for good versus poor collaterals on the outcomes were synthesized using random-effects models. Subgroup and sensitivity analyses were conducted for the primary outcome. Results: Overall, 29 primary studies (2,995 participants) were included in qualitative review, among which 16 studies (1,447 participants) were meta-analyzed. With different imaging modalities and methods to grade the collateral status, good collaterals were found in 33-85% of patients in the individual primary studies (I2=95.2%, p<0.001), with a pooled proportion of 51% (95% CI 40-62%) across all studies. Good pretreatment collaterals was associated with a doubled rate of favorable/good 90-day functional outcome (RR=2.03, 95% CI 1.63-2.51, p<0.001), a higher rate of successful recanalization (RR=1.23, 95% CI 1.04-1.45, p=0.015), and reduced 90-day mortality (RR=0.59, 95% CI 0.43-0.81, p=0.001) after EVT for BAO. None of the primary studies reported the associations of good collaterals with the other secondary outcomes. Subgroup analyses revealed possibly more prominent protective effect of good pretreatment collaterals over the primary outcome, in studies with longer time windows in patient eligibility criteria for EVT (p=0.028 for between-subgroup heterogeneity). Conclusions: In patients with BAO receiving EVT, good pretreatment collateral status was associated with a higher chance of favorable 90-day functional outcome, despite the various methods in grading the collateral circulation. Efforts are needed for more standardized collateral assessment in BAO, for more reliable and generalizable investigations of its clinical implications.

CBF Profile in Computed Tomography Perfusion-Based AutoMIStar Software Predicts Futile Recanalization After Basilar Artery Thrombectomy

“…A recent meta-analysis encompassing 16 real-world cohort studies demonstrated that the presence of robust pretreatment collaterals in BAO patients undergoing EVT was associated with a two-fold likelihood of favorable outcomes at 90 days, a higher probability of successful recanalization, and reduced odds of mortality compared to those with poor collaterals. 33 In our study, we further revealed that a low BATMAN score, which assesses thrombus burden and collateral status, could independently predict FR after EVT in BAO patients, with an AUC of 0.724 (95% CI: 0.589–0.859) and an optimal cut-off value of 7. However, a previous study proposed a BATMAN score of 3 as the optimal threshold for predicting FR following EVT in BAO stroke.…”

Cognition after stroke

“…This is supported by a comprehensive meta-analysis performed by Liu et al., which is also in this month’s issue. 25 Good pre-treatment collaterals were associated with a doubled rate of favorable/good 90 day functional outcome (Relative Risk (RR) = 2.03, 95% confidence interval [CI]: 1.63–2.51, p < 0.001), a higher rate of successful recanalization (RR = 1.23, 95% CI: 1.04–1.45, p = 0.015), and reduced 90 day mortality (RR = 0.59, 95% CI: 0.43–0.81, p = 0.001) after endovascular treatment (EVT) for BAO.…”