Abstract 160: Better Collaterals Are Independently Associated With Post-thrombolysis Recanalization Before Thrombectomy

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Introduction: In acute stroke with large-vessel occlusion (LVO), the goal of intravenous thrombolysis (IVT) is to achieve early recanalization (ER). Over and above occlusion site and thrombus length, better collaterals might also facilitate ER, for instance by improving delivery of the thrombolytic agent to both ends of the thrombus. In this proof-of-concept study, we tested the hypothesis that good collaterals independently predict post-IVT recanalization before thrombectomy. Methods: Patients from the registries of 6 French stroke centres with the following criteria were included: (1) acute stroke with LVO treated with IVT and referred for thrombectomy between May 2015 and March 2017; (2) pre-IVT brain MRI, including diffusion weighted imaging, T2*, MR-angiography and dynamic susceptibility-contrast perfusion-weighted imaging (PWI); and (3) ER evaluated ≤3hrs from IVT start on either first angiographic run or non-invasive imaging. A collateral flow map derived from PWI source data was automatically generated, replicating Kim et al’s previously validated method (Ann. Neurol., 2014). Thrombus length was measured on T2*-based susceptibility vessel sign. Results: Of 224 eligible patients, 37 (16%) experienced ER. ER occurred in 10/83 (12%), 17/116 (15%) and 10/25 (40%) patients with poor/moderate, good and excellent collaterals, respectively. In multivariable analysis, better collaterals were independently associated with ER ( P =0.029), together with shorter thrombus ( P <0.001) and more distal occlusion site ( P =0.010). Conclusions: In our sample of stroke patients imaged with PWI before IVT and intended for thrombectomy, better collaterals were independently associated with post-IVT recanalization, supporting our hypothesis. These findings strengthen the idea that advanced imaging may play a key role for personalized medicine in the thrombectomy era by identifying LVO patients most likely to benefit from IVT.