Journal Article

Greater infarct growth limiting effect of mechanical thrombectomy in stroke patients with poor collaterals

Amaro, Sergio, Chamorro, Angel, Renú, Arturo, Zhao, Yashu, Laredo, Carlos, Rudilosso, Salvatore, Macias, Napoleon, Zarco, Federico, Obach, Victor, Llull, Laura, Montejo, Carmen, Werner, Mariano, Macho, Juan, Urra, Xabier

2019

Overview

ObjectiveStroke 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).MethodsThis 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.ResultsCollaterals 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.ConclusionCompared 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.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Aged / Aged, 80 and over / Blood / Cerebral Angiography - methods / Cerebral Infarction - diagnostic imaging / Cerebral Infarction - surgery / Cohort Studies / Collateral Circulation - physiology / Computed Tomography Angiography - methods / ct perfusion / Female / Humans / Ischemic Stroke / magnetic resonance angiography / Male / Medical imaging / Middle Aged / mri / Patients / Prospective Studies / Registries / Software / Stroke / Stroke - diagnostic imaging / Stroke - surgery / thrombectomy / Thrombectomy - methods / Treatment Outcome / Veins & arteries