Collateral status reperfusion and outcomes after endovascular therapy: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) Registry. - 2022
[en] [en] BACKGROUND: Studies have suggested that collateral status modifies the effect of successful reperfusion on functional outcome after endovascular therapy (EVT). We aimed to assess the association between collateral status and EVT outcomes and to investigate whether collateral status modified the effect of successful reperfusion on EVT outcomes.
METHODS: We used data from the ongoing, prospective, multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry. Collaterals were graded according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) guidelines. Patients were divided into two groups based on angiographic collateral status: poor (grade 0-2) versus good (grade 3-4) collaterals.
RESULTS: Among 2020 patients included in the study, 959 (47%) had good collaterals. Good collaterals were associated with favorable outcome (90-day modified Rankin Scale (mRS) 0-2) (OR 1.5, 95% CI 1.19 to 1.88). Probability of good outcome decreased with increased time from onset to reperfusion in both good and poor collateral groups. Successful reperfusion was associated with higher odds of favorable outcome in good collaterals (OR 6.01, 95% CI 3.27 to 11.04) and poor collaterals (OR 5.65, 95% CI 3.32 to 9.63) with no significant interaction. Similarly, successful reperfusion was associated with higher odds of excellent outcome (90-day mRS 0-1) and lower odds of mortality in both groups with no significant interaction. The benefit of successful reperfusion decreased with time from onset in both groups, but the curve was steeper in the poor collateral group.
CONCLUSIONS: Collateral status predicted functional outcome after EVT. However, collateral status on the pretreatment angiogram did not decrease the clinical benefit of successful reperfusion.
Disciplines :
Neurology
Author, co-author :
Anadani, Mohammad ; Department of Neurology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA manadani@wustl.edu ; Neurology, Neurosurgery, Medical University of South Carolina,College of Medicine, Charleston, South Carolina, USA
Finitsis, Stephanos; Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
Clarençon, Frédéric; Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France ; Neuroradiology, Sorbonne Université, Paris, Paris, France
Richard, Sébastien ; Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
Marnat, Gaultier ; Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
Bourcier, Romain; Neuroradiology, University Hospital of Nantes, Nantes, France
Sibon, Igor; Neuroradiology, CHU de Bordeaux, Bordeaux, France
Dargazanli, Cyril; Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
Arquizan, Caroline; Neurology, CHRU Gui de Chauliac, Montpellier, France
Blanc, Raphael; Interventional Neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
Lapergue, Bertrand; Neurology, Stroke Unit, Foch Hospital, Suresnes, France
Consoli, Arturo ; Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France ; Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
Eugene, Francois ; Radiologie, CHU Rennes, Rennes, France
Vannier, Stephane; Department of Neurology, CHU Rennes, Rennes, Bretagne, France
Spelle, Laurent; Department of Neuroradiolology, CHU Kremlin Bicêtre, Paris, France
Denier, Christian; Neurology, Hopital Bicetre, Le Kremlin-Bicetre, France
Boulanger, Marion; Department of Neurology, CHU Caen, Caen, France
Gauberti, Maxime; Neurology, Stroke Unit, Hôpital Saint Anne, Paris, France
Liebeskind, David S; Neurology, University of California, Los Angeles, Los Angeles, California, USA
de Havenon, Adam ; Department of Neurology, University of Utah, Salt Lake City, Utah, USA
Saleme, Suzana; Neuroradiology, CHU Dupuytren, Limoges, France
Macian, Francisco; Department of Neurology, CHU Limoges, Limoges, France
Rosso, Charlotte; Department of Neurology, CHU Pitié-Salpétrière, Paris, France
Naggara, Olivier; Neurology, Stroke Unit, Hôpital Saint Anne, Paris, France
Turc, Guillaume; Neurology, Stroke Unit, Hôpital Saint Anne, Paris, France
Ozkul-Wermester, Ozlem; Department of Neurology, CHU Rouen, Rouen, Normandie, France
Papagiannaki, Chrisanthi; Department of Neurology, CHU Rouen, Rouen, Normandie, France
Viguier, Alain; Department of Neurology, CHU Toulouse, Toulouse, France
Cognard, Christophe; Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
Le Bras, Anthony ; Department of Radiology, CH Bretagne Atlantique, Vannes, France ; Department of Neurology, CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
Evain, Sarah; Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
Wolff, Valerie; Stroke unit, Strasbourg University Hospitals, Strasbourg, France
Pop, Raoul; Department of Neuroradiolology, CHU Strasbourg, Strasbourg, France
Timsit, Serge; Department of Neurology, CHU Brest, Brest, France
Gentric, Jean-Christophe; Interventional Neuroradiology, CHU Brest, Brest, Bretagne, France
Bourdain, Frédéric; Department of Neurology, CH Côte Basque, Bayonne, France
Veunac, Louis; Department of Neuroradiolology, CH Côte Basque, Bayonne, France
Maier, Benjamin; Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
Gory, Benjamin ; Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50:e344-418.
Ravindran AV, Killingsworth MC, Bhaskar S. Cerebral collaterals in acute ischaemia: Implications for acute ischaemic stroke patients receiving reperfusion therapy. Eur J Neurosci 2021;53:1238-61.
Leng X, Fang H, Leung TWH, et al. Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: A systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2016;87:537-44.
Qian J, Fan L, Zhang W, et al. A metaanalysis of collateral status and outcomes of mechanical thrombectomy. Acta Neurol Scand 2020;142:191-9.
Al-Dasuqi K, Payabvash S, Torres-Flores GA, et al. Effects of collateral status on infarct distribution following endovascular therapy in large vessel occlusion stroke. Stroke 2020;51:e193-202.
de Havenon A, Mlynash M, Kim-Tenser MA, et al. Results from DEFUSE 3: Good collaterals are associated with reduced ischemic core growth but not neurologic outcome. Stroke 2019;50:632-8.
Nambiar V, Sohn SI, Almekhlafi MA, et al. CTA collateral status and response to recanalization in patients with acute ischemic stroke. AJNR Am J Neuroradiol 2014;35:884-90.
Zhang S, Chen W, Tang H, et al. The prognostic value of a four-dimensional CT angiography-based collateral grading scale for reperfusion therapy in acute ischemic stroke patients. PLoS One 2016;11:e0160502.
Berkhemer OA, Jansen IGH, Beumer D, et al. Collateral status on baseline computed tomographic angiography and intra-arterial treatment effect in patients with proximal anterior circulation stroke. Stroke 2016;47:768-76.
Benvegnu F, Richard S, Marnat G, et al. Local anesthesia without sedation during thrombectomy for anterior circulation stroke is associated with worse outcome. Stroke 2020;51:2951-9.
Anadani M, Orabi M, Goyal N. Admission blood pressure and outcome after successful recanalization: A collaborative pooled analysis (P5. 3-009). Wolters Kluwer health, Inc. on behalf of the American Academy of Neurology, 2019.
Higashida RT, Furlan AJ. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003;34:e109-37.
Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med Overseas Ed 2008;359:1317-29.
Liu L, Ding J, Leng X, et al. Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017. Stroke Vasc Neurol 2018;3:117-30.
Elijovich L, Goyal N, Mainali S, et al. CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: A retrospective chart review. J Neurointerv Surg 2016;8:559-62.
Liebeskind DS, Tomsick TA, Foster LD, et al. Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial. Stroke 2014;45:759-64.
Lima FO, Furie KL, Silva GS, et al. The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke 2010;41:2316-22.
Saver JL, Fonarow GC, Smith EE, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA 2013;309:2480-8.
Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: A meta-analysis. JAMA 2016;316:1279-88.
Bang OY, Saver JL, Kim SJ, et al. Collateral flow predicts response to endovascular therapy for acute ischemic stroke. Stroke 2011;42:693-9.
Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998;55:1475-82.
Raychev R, Liebeskind DS, Yoo AJ, et al. Physiologic predictors of collateral circulation and infarct growth during anesthesia-detailed analyses of the GOLIATH trial. J Cereb Blood Flow Metab 2020;40:1203-12.
McVerry F, Liebeskind DS, Muir KW. Systematic review of methods for assessing leptomeningeal collateral flow. AJNR Am J Neuroradiol 2012;33:576-82.
Kauw F, Dankbaar JW, Martin BW, et al. Collateral status in ischemic stroke: A comparison of computed tomography angiography, computed tomography perfusion, and digital subtraction angiography. J Comput Assist Tomogr 2020;44:984-92.
Ben Hassen W, Malley C, Boulouis G, et al. Inter-and intraobserver reliability for angiographic leptomeningeal collateral flow assessment by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. J Neurointerv Surg 2019;11:338-41.
