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Original research
Collateral status reperfusion and outcomes after endovascular therapy: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) Registry
  1. Mohammad Anadani1,2,
  2. Stephanos Finitsis3,
  3. Frédéric Clarençon4,5,
  4. Sébastien Richard6,
  5. Gaultier Marnat7,
  6. Romain Bourcier8,
  7. Igor Sibon9,
  8. Cyril Dargazanli10,
  9. Caroline Arquizan11,
  10. Raphael Blanc12,
  11. Bertrand Lapergue13,
  12. Arturo Consoli14,15,
  13. Francois Eugene16,
  14. Stephane Vannier17,
  15. Laurent Spelle18,
  16. Christian Denier19,
  17. Marion Boulanger20,
  18. Maxime Gauberti21,
  19. David S Liebeskind22,
  20. Adam de Havenon23,
  21. Suzana Saleme24,
  22. Francisco Macian25,
  23. Charlotte Rosso26,
  24. Olivier Naggara21,
  25. Guillaume Turc21,
  26. Ozlem Ozkul-Wermester27,
  27. Chrisanthi Papagiannaki27,
  28. Alain Viguier28,
  29. Christophe Cognard29,
  30. Anthony Le Bras30,31,
  31. Sarah Evain32,
  32. Valerie Wolff33,
  33. Raoul Pop34,
  34. Serge Timsit35,
  35. Jean-Christophe Gentric36,
  36. Frédéric Bourdain37,
  37. Louis Veunac38,
  38. Benjamin Maier39,
  39. Benjamin Gory40
  40. ETIS Registry Investigators
    1. 1Department of Neurology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
    2. 2Neurology, Neurosurgery, Medical University of South Carolina,College of Medicine, Charleston, South Carolina, USA
    3. 3Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
    4. 4Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
    5. 5Neuroradiology, Sorbonne Université, Paris, Paris, France
    6. 6Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
    7. 7Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
    8. 8Neuroradiology, University Hospital of Nantes, Nantes, France
    9. 9Neuroradiology, CHU de Bordeaux, Bordeaux, France
    10. 10Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
    11. 11Neurology, CHRU Gui de Chauliac, Montpellier, France
    12. 12Interventional Neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
    13. 13Neurology, Stroke Unit, Foch Hospital, Suresnes, France
    14. 14Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
    15. 15Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
    16. 16Radiologie, CHU Rennes, Rennes, France
    17. 17Department of Neurology, CHU Rennes, Rennes, Bretagne, France
    18. 18Department of Neuroradiolology, CHU Kremlin Bicêtre, Paris, France
    19. 19Neurology, Hopital Bicetre, Le Kremlin-Bicetre, France
    20. 20Department of Neurology, CHU Caen, Caen, France
    21. 21Neurology, Stroke Unit, Hôpital Saint Anne, Paris, France
    22. 22Neurology, University of California, Los Angeles, Los Angeles, California, USA
    23. 23Department of Neurology, University of Utah, Salt Lake City, Utah, USA
    24. 24Neuroradiology, CHU Dupuytren, Limoges, France
    25. 25Department of Neurology, CHU Limoges, Limoges, France
    26. 26Department of Neurology, CHU Pitié-Salpétrière, Paris, France
    27. 27Department of Neurology, CHU Rouen, Rouen, Normandie, France
    28. 28Department of Neurology, CHU Toulouse, Toulouse, France
    29. 29Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
    30. 30Department of Radiology, CH Bretagne Atlantique, Vannes, France
    31. 31Department of Neurology, CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
    32. 32Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
    33. 33Stroke unit, Strasbourg University Hospitals, Strasbourg, France
    34. 34Department of Neuroradiolology, CHU Strasbourg, Strasbourg, France
    35. 35Department of Neurology, CHU Brest, Brest, France
    36. 36Interventional Neuroradiology, CHU Brest, Brest, Bretagne, France
    37. 37Department of Neurology, CH Côte Basque, Bayonne, France
    38. 38Department of Neuroradiolology, CH Côte Basque, Bayonne, France
    39. 39Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
    40. 40Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
    1. Correspondence to Dr Mohammad Anadani, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA; manadani{at}wustl.edu

    Abstract

    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.

    • stroke
    • thrombectomy
    • blood flow

    Data availability statement

    Data are available upon reasonable request.

    Statistics from Altmetric.com

    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @BenjaminMaierMD

    • Collaborators Endovascular Treatment in Ischemic Stroke (ETIS) Investigators: Rothschild Foundation: Michel Piotin, Raphael Blanc, Hocine Redjem, Simon Escalard, Jean-Philippe Dessilles, François Delvoye, Stanislas Smajda, Benjamin Maier, Hebert Solène, Mikael Mazighi, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, Thomas de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Laurie-Anne Thion, Augustin Lecler, Julien Savatovsky. Foch Hospital: Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, Bertrand Lapergue, David Weisenburger-Lile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Arturo Consoli, Federico Di Maria, Georges Rodesch, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier. CHU Bordeaux: Gaultier Marnat, Florent Gariel, Xavier Barreau, Jérôme Berge, Patrice Menegon, Igor Sibon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon. CHU Nantes: Romain Bourcier, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre. CHRU-Nancy: Benjamin Gory, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Romain, Tonnelet, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Gérard Audibert, Marcela Voicu, Lionel Alb, Marie Reitter, Madalina Brezeanu, Agnès Masson, Adriana Tabarna, Iona Podar, Pauline Bourst, Sarah Guy, Fatiha Bechiri. CHU Limoges: Francisco Macian-Montoro, Suzanna Saleme, Charbel Mounayer, Aymeric Rouchaud, Laetitia Gimenez, Alexandre Cosnard. CHRU Gui de Chauliac: Vincent Costalat, Caroline Arquizan, Cyril Dargazanli, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst. CHU Rennes: Francois Eugene, Stéphane Vannier, Jean-Christophe Ferre, Hélène Raoult, Thomas Ronziere, Maria Lassale, Christophe Paya, Jean-Yves Gauvrit, Clément Tracol, Sophie Langnier-Lemercier, Axelle Maurice, Sabrina Cochennec, Mélanie Pinault. CHU Pitié-Salpétrière: Frédéric Clarençon, Eimad Shotar, Nader Sourour, Stéphanie Lenck, Kévin Premat, Yves Samson, Anne Léger, Sophie Crozier, Flore Baronnet, Sonia Alamowitch, Laure Bottin, Mathon Yger, Vincent Degos. CHU Kremlin-Bicêtre: Laurent Spelle, Christian Denier, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Olivier Chassin, Laura Venditti, Mariana Sarov, Nicolas Legris. Hôpital Saint-Anne: Olivier Naggara, Wagih Ben Hassen, Grégoire Boulouis, Christine Rodriguez-Régent, Denis Trystram, Basile Kerleroux, Guillaume Turc, Valérie Domigo, Catherine Lamy, Julia Birchenall, Clothilde Isabel, François Lun. CHU Toulouse: Alain Viguier, Christophe Cognard, Anne-Christine Januel, Jean-Marc Olivot, Louis Fontaine, Nicolas Raposo, Fabrice Bonneville, Jean-François Albucher, Lionel Calviere, Jean Darcourt, Guillaume Bellanger, Philippe Tall. CHU Caen: Emmanuel Touze, Charlotte Barbier, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Maxime Gauberti. CHU Brest: Serge Timsit, Jean-Christophe Gentric, Julien Ognard, Francois Mathias Merrien. CHU Rouen: Ozlem Ozku Wermester, Evelyne Massardier, Chrisanthi Papagiannaki, Aude Triquenot, Margeaux Lefebvre. CH Bayonne: Frédéric Bourdain, Patricia Bernady, Laurent Lagoarde-Segot, Hélène Cailliez, Louis Veunac, David Higue. CHU Strasbourg: Valérie Wolff, Veronique Quenardelle, Valerie Lauer, Roxana Gheoca, Irene Pierre-Paul, Raoul Pop, Remy Beaujeux, Dan Mihoc, Monica Manisor, Julien Pottecher, Alain Meyer, Thiên-Nga Chamaraux-Tran. CH Vannes: Anthony Le Bras, Sarah Evain, Arnaud Le Guen.

    • Contributors Substantial contributions to the conception or design of the work: MA, SF, AdH, DsL, BG. Acquisition, analysis, and interpretation of the data for the work: FC,SR, GM, RB, IS, CD, CA, RB, BL, AC, FE, SV, LS, CD, MB, MG, SS, FM, CR, ON, GT, OO, CP, AV, CC, AlB, SE, VW, RP, ST, JG, FB, LV, BM. Drafting the work or revising it critically for important intellectual content: MA; SF, AdH, DsL, BG.

    • 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.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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