The association between collateral status, recanalization and long term outcome in stroke patients treated with stent retrievers – Are there indications not to perform thrombectomy based on CT angiography?

Nordmeyer, Henning; Webering, Nadine; Chapot, René; Hadisurya, Jeffrie; Heddier, Markus; Stracke, Paul; Berger, Klaus; Isenmann, Stefan; Weber, Ralph

doi:10.1016/j.neurad.2016.12.009

Cited by 26 publications

(16 citation statements)

References 26 publications

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“…A more recent study by Nordmeyer et al. 21 took use of the unmodified Tan Score, which uses more classes than the mTan Score. They found that the score is an independent predictor of death in follow-up after discharge, but, similarly to our results, could not find a significant effect in dichotomi s ed mRS.…”

Section: Discussionmentioning

confidence: 99%

“…The divergent results between this trial and our results regarding differentiation of both outcome groups may be caused by the larger population size and the different treatment. A more recent study by Nordmeyer et al 21 took use of the unmodified Tan Score, which uses more classes than the mTan Score. They found that the score is an independent predictor of death in follow-up after discharge, but, similarly to our results, could not find a significant effect in dichotomised mRS.…”

Section: Predictivity Of Functional Outcomementioning

confidence: 99%

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Systematic evaluation of computed tomography angiography collateral scores for estimation of long-term outcome after mechanical thrombectomy in acute ischaemic stroke

et al. 2019

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Purpose This study compares computed tomography angiography-based collateral scoring systems in regard to their inter-rater reliability and potential to predict functional outcome after endovascular thrombectomy, and relates them to parenchymal perfusion as measured by computed tomography perfusion. Methods Eighty-four patients undergoing endovascular thrombectomy in anterior circulation ischaemic stroke were enrolled. Modified Tan Score, Miteff Score, Maas Score and Opercular Index Score ratio were assessed in pre-interventional computed tomography angiographies independently by two readers. Collateral scores were tested for inter-rater reliability by weighted-kappa, for correlations with three-months modified Rankin Scale, and their potential to differentiate between patients with favourable (modified Rankin Scale ≤2) and poor outcome (modified Rankin Scale ≥3). Correlations with relative cerebral blood volume and relative cerebral blood flow were tested in patients with available computed tomography perfusion. Results Very good inter-rater reliability was found for Modified Tan, Miteff and Opercular Index Score ratio, and substantial reliability for Maas. There were no significant correlations between collateral scores and three-months modified Rankin Scale, but significant group differences between patients with favourable and poor outcome for Maas, Miteff and Opercular Index Score ratio. Miteff and Maas were significant predictors of favourable outcome in binary logistic regression analysis. Miteff best differentiated between both outcome groups in receiver-operating characteristics, and Maas reached highest sensitivity for favourable outcome prediction of 96%. All collateral scores significantly correlated with mean relative cerebral blood volume and relative cerebral blood flow. Conclusions Computed tomography angiography scores are valuable in estimating functional outcome after mechanical thrombectomy and reliable across readers. The more complex scores, Maas and Miteff, show the best performances in predicting favourable outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Predictivity Of Functional Outcomementioning

confidence: 99%

Systematic evaluation of computed tomography angiography collateral scores for estimation of long-term outcome after mechanical thrombectomy in acute ischaemic stroke

et al. 2019

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“…On a univariate level we could replicate findings that whole brain collateral vessel status as well as risk factors such as atherosclerosis, elevated glucose levels on admission as well as interventional treatment are related to the functional and radiological outcome of the patients [6][7][8][9][10]. This is of particular interest since we used a novel scoring method to evaluate the collateral vessel status of the whole brain.…”

Section: Discussionmentioning

confidence: 58%

Prediction contribution of the cranial collateral circulation to the clinical and radiological outcome of ischemic stroke

et al. 2020

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Background and Aim The extent of penumbra tissue and outcome in stroke patients depend on the collateral cranial vasculature. To provide optimal individualized care for stroke patients in the emergency room setting we investigated the predictive capability of a stringent evaluation of the collateral vessels in ischemic stroke on clinical outcome and infarct size. Methods We retrospectively studied uniform clinical and radiological data of 686 consecutive patients admitted to the emergency department with suspected acute ischemic stroke. Cranial collateral vasculature status was graded using the initial CT-angiography. Outcome was measured by mRS, NIHSS and final infarct size at hospital discharge. All data were used to build a linear regression model to predict the patients´ outcome. Results Univariate and multivariate analyses showed significant effects of the whole brain collateral vessel score on all outcome variables. Atherosclerosis and piale collateral status were associated with the final infarct volume (FIV). Atherosclerosis and age were associated with the NIHSS at discharge. The presence of atherosclerosis, glucose level on admission and age were associated with the mRS at discharge. The multivariate models were able to predict 29% of the variance of the mRS at discharge, 24% of the variance in FIV and 17% of the variance of the NIHSS at discharge. The whole brain collateral status and the presence of atherosclerosis were the most relevant predictors for the clinical and radiological outcome. Conclusion The whole brain collateral vasculature status is clearly associated with clinical and radiological outcome but in a multivariate model seems not sufficiently predictive for FIV, mRS and NIHSS outcome at discharge in non-preselected patients admitted to the emergency department with ischemic stroke.

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“…However, other studies showed opposite results. After a mean follow-up period of 5.2 months, no significant association was found between collateral status (OR: 1.681 and 95% CI: 0.683–4.140) and successful reperfusion in an observational study [ 19 ]. The data of our study supported that, in patients with ischemic stroke after mechanical thrombectomy, the pretreatment collateral status was associated with successful reperfusion and improved clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

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

Guo

Jiang

et al. 2022

Journal of Healthcare Engineering

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Background. Successful mechanical thrombectomy (MT) requires reliable, noninvasive selection criteria. We aimed to investigate the association of collateral status and clinical outcomes after MT in patients with ischemic stroke due to anterior circulation occlusion. Methods. 109 patients with poor collaterals and 110 aged, sex-matched patients with good collaterals were enrolled in the study. Collateral circulation was estimated by the CT angiography with a 0–3 scale. The collateral status was categorized as poor collaterals (scores 0–1) and good collaterals (scores 2-3). The reperfusion was assessed by the modified Treatment in Cerebral Infarction scale (mTICI, score 0/1/2a/2b/3). The clinical outcomes included the scores on the modified Rankin scale (mRS, ranging from 0 to 6) and death 90 days after mechanical thrombectomy. Results. Patients with greater scores of collateral status were more likely to achieve successful reperfusion (mTICI 2b/3). Patients with good collaterals were significantly associated with a higher chance of achieving mRS of 0–1 at 90 days (adjusted ORs: 4.55; 95% CI: 3.17–7.24; and P < 0.001) and a lower risk of death at 90 days (adjusted ORs: 0.87; 95% CI: 4.0%–28.0%; and P = 0.012) compared to patients with poor collaterals. In subgroup analyses, patients with statin use seem to benefit more from the effect of collateral status on good mRS (≤2). Conclusion. Among patients with acute ischemic stroke caused by anterior circulation occlusion, better collateral status is associated with higher scores on mRS and lower mortality after mechanical thrombectomy. Statin use might have an interaction with the effect of collateral status.

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The association between collateral status, recanalization and long term outcome in stroke patients treated with stent retrievers – Are there indications not to perform thrombectomy based on CT angiography?

Cited by 26 publications

References 26 publications

Systematic evaluation of computed tomography angiography collateral scores for estimation of long-term outcome after mechanical thrombectomy in acute ischaemic stroke

Systematic evaluation of computed tomography angiography collateral scores for estimation of long-term outcome after mechanical thrombectomy in acute ischaemic stroke

Prediction contribution of the cranial collateral circulation to the clinical and radiological outcome of ischemic stroke

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

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