Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients.
OBJECTIVE
Clinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.


METHODS
In our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT-CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data-driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.


RESULTS
Successful angiographic reperfusion (OR 26.50; 95%-CI 9.33-83.61) and good collaterals (OR 9.69; 95%-CI 2.28-59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%-CI 0.14-0.85), younger age (OR 0.88; 95%-CI 0.83-0.92) and higher NCCT ASPECTS (OR 2.54; 95%-CI 1.01-6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.


CONCLUSIONS
CTA-collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA-collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA-collaterals.
Neuroradiology University Hospital Carl Gustav Carus Dresden Germany.
Johannes C
0000-0001-7465-8700
JC
Gerber
Radiology University Hospital Carl Gustav Carus Dresden Germany.
Marketa
M
Petrova
Neuroradiology University Hospital Carl Gustav Carus Dresden Germany.
Pawel
P
Krukowski
Institute of Medical Informatics and Biometry Medizinische Fakultät Carl Gustav Carus Technische Universität Dresden Germany.
Matthias
M
Kuhn
Neuroradiology University Hospital Carl Gustav Carus Dresden Germany.
Andrij
A
Abramyuk
Neurology University Hospital Carl Gustav Carus Dresden Germany.
Ulf
U
Bodechtel
Neurology Elblandklinikum Meissen Germany.
Imanuel
I
Dzialowski
Neuroradiology University Hospital Carl Gustav Carus Dresden Germany.
Kay
K
Engellandt
Neuroradiology University Hospital Carl Gustav Carus Dresden Germany.
Hagen
H
Kitzler
Neurology University Hospital Carl Gustav Carus Dresden Germany.
Lars-Peder
LP
Pallesen
Neurology University Hospital Carl Gustav Carus Dresden Germany.
Hauke
H
Schneider
Neuroradiology University Hospital Carl Gustav Carus Dresden Germany.
Ruediger
R
von Kummer
Neurology University Hospital Carl Gustav Carus Dresden Germany.
Volker
V
Puetz
Neuroradiology University Hospital Carl Gustav Carus Dresden Germany.
Jennifer
J
Linn
Angiography; endovascular treatment; ischemic stroke; leptomeningeal collaterals
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