title: Effect of the Interaction between Recanalization and Collateral Circulation on Functional Outcome in Acute Ischaemic Stroke.
abstract: Identification of patients with acute ischaemic stroke who could most benefit from arterial recanalization after endovascular treatment remains an unsettled issue. Although several classifications of collateral circulation have been proposed, the clinical role of collaterals is still debated. We evaluated the effect of the collateral circulation in relation to recanalization as a predictor of clinical outcome. Data were prospectively collected from 103 patients consecutively treated for proximal middle cerebral or internal carotid artery occlusion. The collateral circulation was evaluated with a novel semiquantitative-qualitative score, the Careggi collateral score (CCS), in six grades. Both CCS and recanalization grades (TICI) were analysed in relation to clinical outcome. A statistical analysis was performed to evaluate the effect of interaction between recanalization and collateral circulation on clinical outcome. Out of the 103 patients, 37 (36.3%) had poor collaterals, and 65 (63.7%) had good collaterals. Patients with good collaterals had lower basal National Institute of Health Stroke Scale (NIHSS), more distal occlusion, smaller lesions at 24h CT scan and better functional outcome. After multivariate analysis, the interaction between recanalization and collateral grades was significantly stronger as a predictor of good outcome (OR 6.87, 95% CI 2.11-22.31) or death (OR 4.66, 95%CI 1.48-14.73) compared to the effect of the single variables. Collaterals showed an effect of interaction with the recanalization grade in determining a favourable clinical outcome. Assessment of the collateral circulation might help predict clinical results after recanalization in patients undergoing endovascular treatment for acute ischaemic stroke.
authors.affiliation: Interventional Neuroradiology Unit, Heart and Vessels Department, Careggi University Hospital; Florence, Italy - onemed21@gmail.com.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mangiafico
authors.affiliation: Department of Neuroscience, Careggi University Hospital; Florence, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Saia
authors.affiliation: Stroke Unit, Heart and Vessels Department, Careggi University Hospital; Florence, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Nencini
authors.affiliation: Department of Neuroscience, Careggi University Hospital; Florence, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Romani
authors.affiliation: Stroke Unit, Heart and Vessels Department, Careggi University Hospital; Florence, Italy.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Palumbo
authors.affiliation: Department of Neuroscience, Careggi University Hospital; Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pracucci
authors.affiliation: Interventional Neuroradiology Unit, Heart and Vessels Department, Careggi University Hospital; Florence, Italy.
authors.forename: Arturo
authors.initials: A
authors.lastname: Consoli
authors.affiliation: Interventional Neuroradiology Unit, Heart and Vessels Department, Careggi University Hospital; Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rosi
authors.affiliation: Interventional Neuroradiology Unit, Heart and Vessels Department, Careggi University Hospital; Florence, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Renieri
authors.affiliation: Interventional Neuroradiology Unit, Heart and Vessels Department, Careggi University Hospital; Florence, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Nappini
authors.affiliation: Interventional Neuroradiology Unit, Heart and Vessels Department, Careggi University Hospital; Florence, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Limbucci
authors.affiliation: Stroke Unit, Heart and Vessels Department, Careggi University Hospital; Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
authors.affiliation: Heart and Vessels Department, Careggi University Hospital; Florence, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D002533:Cerebral Angiography; D003097:Collateral Circulation; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: acute stroke; acute stroke intervention; angiography; collaterals; endovascular treatment; outcome