title: Good collateral circulation predicts favorable outcomes in intravenous thrombolysis: a systematic review and meta-analysis.
abstract: Baseline collateral status has been correlated with outcomes of acute ischaemic stroke patients receiving intravenous thrombolysis (IVT) in previous studies. We carried out the current systematic review and meta-analysis to synthesize currently available evidence regarding such correlations.
  
  
  
  Full-text articles published since 2000 were retrieved and screened. The overall effect sizes of good versus poor collateral status over a series of outcomes and certain baseline features were estimated by random-effects models and presented in risk ratios (RRs) or mean differences.
  
  
  
  Overall, 28 (3057 patients) and 14 (1584 patients) studies were included in qualitative and quantitative synthesis, respectively. Compared with poor pre-treatment collateral status, good collaterals showed a beneficial effect over the primary outcome of a favorable functional outcome at 3 or 6 months [RR, 2.45; 95% confidence interval, 1.94-3.09; P < 0.001] in acute ischaemic stroke patients receiving IVT treatment. However, such an effect tended to be different between studies with prescribed time windows of 3, 4.5 and > 4.5 h (up to 7 h), with the RRs being 2.21, 2.48 and 5.00, respectively (I2= 53%). Good pre-treatment collaterals were also associated with a smaller infarct size at baseline, and a lower rate of symptomatic intracranial hemorrhage and a higher rate of neurological improvement early after IVT treatment.
  
  
  
  The present study has demonstrated the prognostic value of baseline collateral circulation for outcomes of acute ischaemic stroke patients receiving intravenous reperfusion therapies, studied with different time windows of up to 7 h after ictus for IVT therapy.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: X
authors.initials: X
authors.lastname: Leng
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: L
authors.initials: L
authors.lastname: Lan
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: L
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: T W
authors.initials: TW
authors.lastname: Leung
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: K S
authors.initials: KS
authors.lastname: Wong
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D003097:Collateral Circulation / Q000502:physiology*; D006801:Humans; D007262:Infusions, Intravenous; D011379:Prognosis; D015424:Reperfusion; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy
keywords: acute ischaemic stroke; collateral circulation; intravenous thrombolysis; systematic review and meta-analysis