Abstract
Introduction: Collateral circulation plays a pivotal role in acute ischemic stroke due to large vessel occlusion and may be affected by multiple variables during sedation for endovascular therapy (EVT). Identification of potentially modifiable physiologic predictors of collateral circulation will help to refine the most optimal anesthetic strategy in clinical practice and future trials. Methods: We conducted detailed analyses of the GOLIATH database to identify 1) predictors of collateral circulation grade and 2) infarct growth at 24h. Angiographic collaterals immediately prior EVT were graded by two investigators, followed by consensus adjudication. We also modified the ASITN collateral scale by dividing grade 2 in two separate categories: 2- (persistent filling defect in >50% of the ischemic territory) and 2+ (<50% of the territory) and sought to determine its impact on clinical outcome and 24h infarct growth. Multivariable analysis was used to identify predictors of collaterals and infarct growth. Results: Collaterals were evaluable in 62% (80/128) of analyzed patients, including grades 1 (n=9), 2- (n=19), 2+ (n=31), 3 (n=21). Ordinal analysis demonstrated nominal, but non-significant association between modified ASITN scale and infarct growth (figure 1). There was no correlation between collaterals and outcome. Among all analyzed variables [Age, NIHSS, ASPECTS, HTN, DM, time to groin, end tidal CO2 levels, general anesthesia, Propofol dose, Phenylephrine dose, mean arterial pressure (MAP) drop < 70 mmhg ], the most significant predictor of infarct growth at 24h was Phenylephrine dose (beta 6.13; p=0.026), and the most significant predictor of collateral grade was MAP < 70 mmhg (OR 0.34; p = 0.044). Conclusions: ASITN grade 2-/+ may be useful as distinct categories for collateral grading. Higher phenylephrine dose is a strong predictor of infarct growth, while lower MAP strongly correlates with worse angiographic collaterals during sedation for EVT.
Published Version
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