Objective Stroke patients with good collateral circulation achieve the best recovery after mechanical thrombectomy (MT) but strict imaging selection may result in untreated patients that could benefit from MT. We assessed whether the extent of collaterals had modifying effects on the amount of ischemic tissue saved from infarction with MT over best medical treatment (BMT).
Methods This was a single center cohort of consecutive patients (n=339) with proximal occlusions in the carotid territory. Patients were categorized according to a four point category scale on CT angiography as having good (scores 2–3) or poor (scores 0–1) collaterals. The primary outcome measure was the interaction between collaterals and MT on infarct growth. The secondary outcome assessed the treatment effect of MT over BMT on functional status in relation to collateral status. Safety outcomes were mortality and symptomatic intracranial hemorrhage.
Results Collaterals had a modifying effect of MT on infarct growth (P=0.004), with a greater reduction in 96 patients with poor collaterals (38.8 mL) than in 243 patients with good collaterals (1.9 mL). There was also a significant (P<0.001) interaction between the effect of MT and functional outcome in relation to collateral status, with more benefits of MT in patients with poor collaterals. MT was associated with lower mortality than BMT in patients with poor collaterals only.
Conclusion Compared with BMT, the use of MT in the early time window in large vessel stroke results in a more substantial limitation of infarct growth in patients with poor collaterals.
- ct perfusion
- magnetic resonance angiography
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AR and CL contributed equally.
Contributors ARJ and CL made substantial contributions to the conception and design of the study, collected and analyzed the clinical data, acquired, processed and analyzed the radiological data, and drafted the manuscript for intellectual concept. CM made substantial contributions to the collection and analysis of the clinical data. YZ made substantial contributions to the acquisition, processing, and analyzing of the radiological data. SR, LL, SA, and VO made substantial contributions to the collection and analysis of the clinical data. NM, FZ, MW, and JM made substantial contributions to the acquisition, processing, and analysis of the radiological data. AC and XU made substantial contributions to the conception and design of the study, collected and analyzed the clinical data, drafted the manuscript for intellectual content, and revised the draft critically.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests None declared.
Ethics approval The local ethics committee at the Hospital Clinic approved the study (reg code HCB/2018/0680).
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.
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