Presence of the Posterior Communicating Artery Contributes to the Clinical Outcome After Endovascular Treatment of Patients with MCA Occlusions

Friedrich, Benjamin; Kempf, F; Boeckh‐Behrens, Tobias; Fischer, Johanna C.; Lehm, Manuel; Bernd, Maria; Wunderlich, Silke; Mönch, Sebastian; Zimmer, Claus; Maegerlein, Christian

doi:10.1007/s00270-018-2029-6

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Second, the rate of PComA patency may vary according to different parameters (setting of a large vessel occlusion, modality of assessment, definitions between absence, hypoplasia, and presence). 6,12,13 Therefore, it is possible that the important number of patients without a PComA is partly explained by our methodology (assessment on the first angiographic run, no computed tomography angiography adjudication). Third, no data regarding the hemodynamic management before EVT (notably in case of intravenous thrombolysis) and during the patient’s transfer was available.…”

Section: Discussionmentioning

confidence: 99%

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Association of Hypotension During Thrombectomy and Outcomes Differs With the Posterior Communicating Artery Patency

Maïer

Robichon

Bourcier³

et al. 2021

Stroke

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Background and Purpose: Hypotension during endovascular therapy for acute ischemic stroke is associated with worse functional outcomes (FO). Given its important role in intracranial hemodynamics, we investigated whether hypotension during endovascular therapy had the same effect on FO according to the posterior communicating artery (PComA) patency. Methods: We performed a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Patients were included if they had middle cerebral artery occlusions. Primary outcome was favorable FO, defined by a modified Rankin Scale scores between 0 and 2 at 3 months. Results: One hundred forty-eight patients with middle cerebral artery occlusion were included. In patients with no PComA, an increase in minimum mean arterial pressure was positively associated with favorable FO (odds ratio per 10 mm Hg increase, 1.59 [95%CI, 1.11–2.25]; P =0.010), whereas no association was found in patients with a PComA (odds ratio, 0.77 [95% CI, 0.54–1.08]; P =0.12). Patients with no PComA and longer cumulative time with mean arterial pressure <90 mm Hg or systolic blood pressure <140 mm Hg had significantly lower rates of favorable FO, with an odds ratio per 10-minute increase of 0.75 (95% CI, 0.59–0.94; P =0.010) and 0.74 (95% CI, 0.60–0.91; P =0.003), but not in patients with a PComA. Conclusions: Hypotension during endovascular therapy for middle cerebral artery occlusion is consistently associated with worse FO in patients with no PComA but not in those with a PComA. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02523261.

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Section: Discussionmentioning

confidence: 99%

“…This hypothesis is substantiated by a preliminary study that showed worse FO in patients treated with EVT that had no PComA. 6 Altogether, it is plausible that hypotension during EVT may have a varying effect on FO according to the patency of the PComA. We sought to evaluate this question in patients with an M1/M2 occlusion.…”

mentioning

confidence: 98%

Association of Hypotension During Thrombectomy and Outcomes Differs With the Posterior Communicating Artery Patency

Maïer

Robichon

Bourcier³

et al. 2021

Stroke

View full text Add to dashboard Cite

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“…Using magnetic resonance angiography (MRA) in 874 men and 990 women, Hindenes et al found 47 unique variations in the Circle of Willis, where the absence of the posterior communicating arteries is the most common variation ( 27 ). This is clinically relevant, as acute MCA occlusions in patients with a present ipsilateral posterior communicating artery are more likely to have favorable functional outcomes (i.e., modified Rankin score <2) after successful endovascular mechanical thrombectomy, compared to those without an ipsilateral posterior communicating artery ( 28 ). The recruitment of leptomeningeal collaterals is hypothesized to occur when the primary collaterals have failed to provide adequate blood flow to the ischemic regions ( 24 ), since leptomeningeal arteries are primarily observable in the later phases of ischemia ( 29 ).…”

Section: The Cerebral Collateral Circulation Systemmentioning

confidence: 99%

Pre-stroke Physical Activity and Cerebral Collateral Circulation in Ischemic Stroke: A Potential Therapeutic Relationship?

et al. 2022

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Favorable cerebral collateral circulation contributes to hindering penumbral tissue from progressing to infarction and is associated with positive clinical outcomes after stroke. Given its clinical importance, improving cerebral collateral circulation is considered a therapeutic target to reduce burden after stroke. We provide a hypothesis-generating discussion on the potential association between pre-stroke physical activity and cerebral collateral circulation in ischemic stroke. The recruitment of cerebral collaterals in acute ischemic stroke may depend on anatomical variations, capacity of collateral vessels to vasodilate, and individual risk factors. Physical activity is associated with improved cerebral endothelial and vascular function related to vasodilation and angiogenic adaptations, and risk reduction in individual risk factors. More research is needed to understand association between cerebral collateral circulation and physical activity. A presentation of different methodological considerations for measuring cerebral collateral circulation and pre-stroke physical activity in the context of acute ischemic stroke is included. Opportunities for future research into cerebral collateral circulation, physical activity, and stroke recovery is presented.

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Circle of Willis integrity in acute middle cerebral artery occlusion: does the posterior communicating artery matter?

Sadeh-Gonik,

Budylev,

Krivitzky

et al. 2023

J NeuroIntervent Surg

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BackgroundCollateral circulation is an important determinant of outcome in people with acute ischemic stroke due to large vessel occlusion (LVO).ObjectiveTo explore the impact of the circle of Willis (CW) anatomical characteristics ipsilateral to the occlusion site, particularly the posterior communicating artery (PComA) and the A1-portion of the anterior cerebral artery (A1-ACA), on stroke outcomes in a cohort of patients with LVO and middle cerebral artery (MCA) occlusion, undergoing endovascular thrombectomy (EVT).MethodsThis is a retrospective cohort study performed in a comprehensive tertiary stroke center. The study population consisted of consecutive patients with LVO with proximal MCA occlusion (M1) between June 2016 and April 2021, undergoing EVT. Demographic, clinical, and imaging information was extracted from patient files. Patency and diameters of ipsilateral A1-ACA and PComA were manually measured on admission CT angiography images in the core laboratory.ResultsOne hundred and five patients with LVO comprised the study cohort, mean age 72.3 years, 43.8% were male, mean National Institutes of Health Stroke Scale score at admission 15.2. The cohort was grouped according to CW vessel characteristics. On univariate analysis, a well-developed PComA was associated with lower rates of hemorrhagic transformation (1.8% vs 14.3%, P=0.01) and a trend towards lower mortality rates (8.9% vs 20.4%, P=0.08).On multivariable regression analysis a well-developed PComA emerged as an independent predictor for survival (aOR=0.09, 95% CI 0.01 to 0.4 for survival at discharge, P=0.009, aOR=0.22, 95% CI 0.05 to 0.8 for survival at 90 days, P=0.02).ConclusionsIn a cohort of patients with LVO due to M1 occlusion undergoing EVT, a well-developed PComA was associated with significantly lower hemorrhagic transformation rates, a trend towards better functional outcomes, and independently predicted survival. Larger studies are needed to understand the differential effect of CW collateral conduits on stroke outcome and evaluate the practicality of incorporating such factors in the clinical decision-making process prior to EVT.

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Presence of the Posterior Communicating Artery Contributes to the Clinical Outcome After Endovascular Treatment of Patients with MCA Occlusions

Cited by 4 publications

References 28 publications

Association of Hypotension During Thrombectomy and Outcomes Differs With the Posterior Communicating Artery Patency

Association of Hypotension During Thrombectomy and Outcomes Differs With the Posterior Communicating Artery Patency

Pre-stroke Physical Activity and Cerebral Collateral Circulation in Ischemic Stroke: A Potential Therapeutic Relationship?

Circle of Willis integrity in acute middle cerebral artery occlusion: does the posterior communicating artery matter?

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