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Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: Clinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.

Methods: In our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT‐CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data‐driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.

Results: Successful angiographic reperfusion (OR 26.50; 95%‐CI 9.33–83.61) and good collaterals (OR 9.69; 95%‐CI 2.28–59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%‐CI 0.14–0.85), younger age (OR 0.88; 95%‐CI 0.83–0.92) and higher NCCT ASPECTS (OR 2.54; 95%‐CI 1.01–6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.

Conclusions: CTA‐collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA‐collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA‐collaterals.

No MeSH data available.


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Mentions: During the observation period, we treated 180 ischemic stroke patients with EVT. Of these, we had to exclude 87 patients, leaving 93 patients (48 men; 52%) for analysis (Fig. 1). Their median baseline NIHSS score was 17 (range 1–34) and median age was 69 years (range 36–90; Table 1). Intravenous thrombolysis (IVT) was administered in 56 (60%) patients prior to EVT (bridging therapy). The mean onset to IVT treatment time was 125 min (median 119 min, IQR 73 min).


Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients
Patient flow chart.
© Copyright Policy - creativeCommonsBy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036435&req=5

brb3513-fig-0001: Patient flow chart.
Mentions: During the observation period, we treated 180 ischemic stroke patients with EVT. Of these, we had to exclude 87 patients, leaving 93 patients (48 men; 52%) for analysis (Fig. 1). Their median baseline NIHSS score was 17 (range 1–34) and median age was 69 years (range 36–90; Table 1). Intravenous thrombolysis (IVT) was administered in 56 (60%) patients prior to EVT (bridging therapy). The mean onset to IVT treatment time was 125 min (median 119 min, IQR 73 min).

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: Clinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.

Methods: In our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT‐CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data‐driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.

Results: Successful angiographic reperfusion (OR 26.50; 95%‐CI 9.33–83.61) and good collaterals (OR 9.69; 95%‐CI 2.28–59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%‐CI 0.14–0.85), younger age (OR 0.88; 95%‐CI 0.83–0.92) and higher NCCT ASPECTS (OR 2.54; 95%‐CI 1.01–6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.

Conclusions: CTA‐collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA‐collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA‐collaterals.

No MeSH data available.