title: The association between collateral status, recanalization and long term outcome in stroke patients treated with stent retrievers - Are there indications not to perform thrombectomy based on CT angiography?
abstract: OBJECTIVE
  To investigate the association between baseline pial collateral status on computed tomography angiography (CTA) with recanalization and functional outcome in patients with acute anterior circulation stroke treated with stent retriever thrombectomy.
  
  
  METHODS
  Retrospective analysis of 87 patients from a prospective thrombectomy registry. Collateral status on CTA source images was categorized into good, moderate, and poor with the Tan and Miteff scores by two-blinded readers. Association between CTA collateral status and successful recanalization was investigated with univariate regression analysis. Multivariate logistic regression was used to analyse the association between collateral score and favourable clinical outcome (mRS 0-2) and death at follow-up.
  
  
  RESULTS
  Mean age was 72.5 years and baseline median NIHSS score was 15. Patients with poor collaterals on Tan score had a significant higher mortality compared with moderate or good collaterals during a mean follow-up period of 5.2 months (85.7% vs. 30.6% vs. 25.7%, P<0.001). Univariate logistic regression analysis did not show a significant association between Tan score (OR 1.681, 95% CI 0.683-4.140) and successful recanalization. Higher age (OR 1.067, 95% CI 1.013-1.124; P=0.015) and lower Tan score (OR 0.421, 95% CI 0.192-0.922; P=0.031) were independent predictors of death at follow-up on multivariate analysis. The Miteff collateral score could be assessed only in 65 of the 87 patients and the Tan collateral score had a higher interrater reliability.
  
  
  CONCLUSIONS
  Poor collaterals on CTA were associated with a very high rate of fatal outcome in anterior circulation stroke patients despite a high rate of successful recanalization with stent retrievers.
authors.affiliation: Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131 Essen, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Nordmeyer
authors.affiliation: Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131 Essen, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Webering
authors.affiliation: Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131 Essen, Germany.
authors.forename: Rene
authors.initials: R
authors.lastname: Chapot
authors.affiliation: Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131 Essen, Germany.
authors.forename: Jeffrie
authors.initials: J
authors.lastname: Hadisurya
authors.affiliation: Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131 Essen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Heddier
authors.affiliation: Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131 Essen, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Stracke
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Helios Universitätsklinikum Wuppertal, University Witten/Herdecke, Heusnerstr. 40, 42283 Wuppertal, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Isenmann
authors.affiliation: Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131 Essen, Germany. Electronic address: ralph.weber@krupp-krankenhaus.de.
authors.forename: Ralph
authors.initials: R
authors.lastname: Weber
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D003097:Collateral Circulation; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Collaterals; Computed tomography angiography; Ischemic stroke; Mechanical thrombectomy; Stent retriever