title: Impact of collaterals on successful revascularization in Solitaire FR with the intention for thrombectomy.
abstract: OBJECTIVE
  Collaterals at angiography before endovascular therapy were analyzed to ascertain the effect on a novel end point of successful revascularization without symptomatic hemorrhage in the Solitaire FR With the Intention for Thrombectomy (SWIFT) study.
  
  
  METHODS
  Collateral grade (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology) on baseline angiography was independently assessed, blind to other data, with statistical analyses delineating the relationship with clinical, laboratory, and imaging parameters.
  
  
  RESULTS
  Angiographic data on collaterals were available in 119 of 144 subjects (mean age, 67±12 years; 52% woman; median National Institutes of Health Stroke Scale, 18 [range, 8-28]). Worse collaterals were noted in subjects with elevated baseline blood glucose (P=0.013) and those with elevated baseline systolic blood pressure (P=0.039). Multivariate predictors of partial or worse collaterals included absence of prior hypertension (odds ratio, 4.049, P=0.012), smoking history (odds ratio, 3.822; P=0.013), and higher blood glucose (odds ratio, 1.017; P=0.022). Collaterals were strongly related to Alberta Stroke Program Early CT Score (ASPECTS) at baseline (0-1: median 8 [3-10]; 2-9 [5-10]; 3-9 [7-10]; 4-9 [8-10]; P<0.001) and 24 hours (0-1: median 1 [0-5]; 2-6 [0-10]; 3-8 [0-10]; 4-8 [4-8]; P<0.001). Better collaterals were linked with Thrombolysis in Cerebral Infarction 2b/3 reperfusion (P=0.019), better median National Institutes of Health Stroke Scale at day 7/discharge (P<0.001), and better day 90 modified Rankin Scale (P<0.001). Better collateral grade was associated with successful revascularization without symptomatic hemorrhage, mean 2.3 (95% confidence interval, 2.1-2.5) versus 1.9 (95% confidence interval, 1.7-2.2), P=0.021.
  
  
  CONCLUSIONS
  Better collaterals were associated with lower glucose, lower blood pressure, smaller baseline infarcts in SWIFT, and greater likelihood of successful revascularization without hemorrhage and good clinical outcomes.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01054560.
authors.affiliation: From the UCLA Stroke Center (D.S.L., R.J., J.L.S.); Emory University School of Medicine, Atlanta, GA (R.G.N.); and Medical College of Wisconsin, Froedtert Hospital, Milwaukee (O.O.Z.). davidliebeskind@yahoo.com.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: From the UCLA Stroke Center (D.S.L., R.J., J.L.S.); Emory University School of Medicine, Atlanta, GA (R.G.N.); and Medical College of Wisconsin, Froedtert Hospital, Milwaukee (O.O.Z.).
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.affiliation: From the UCLA Stroke Center (D.S.L., R.J., J.L.S.); Emory University School of Medicine, Atlanta, GA (R.G.N.); and Medical College of Wisconsin, Froedtert Hospital, Milwaukee (O.O.Z.).
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: From the UCLA Stroke Center (D.S.L., R.J., J.L.S.); Emory University School of Medicine, Atlanta, GA (R.G.N.); and Medical College of Wisconsin, Froedtert Hospital, Milwaukee (O.O.Z.).
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
authors.affiliation: From the UCLA Stroke Center (D.S.L., R.J., J.L.S.); Emory University School of Medicine, Atlanta, GA (R.G.N.); and Medical College of Wisconsin, Froedtert Hospital, Milwaukee (O.O.Z.).
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003097:Collateral Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D017131:Thrombectomy / Q000295:instrumentation
chemical_list: D001786:Blood Glucose
keywords: collaterals; endovascular therapy; revascularization; stroke