Abstract 4036: Collateral Status And Stroke Severity Is Important In Thrombolytic Therapy Of Internal Carotid Artery Occlusion

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Background: Despite the poor prognosis in patient with internal carotid artery occlusion (ICAO), optimal management is uncertain. However, mechanical thrombectomy showed promising results in recanalization of ICAO, the prognosis of patients with ICAO after thrombolytic therapy is still unsatisfactory. The futile recanalization of ICAO might be related from the initial poor collateral flow and severe stroke. We performed a retrospective analysis of clinical and imaging data of patients who received endovascular treatments due to acute symptomatic ICAO to reveal the factors associated with good outcome at 3 months. Methods: From the stroke database, patients with ICAO were recruited. Inclusion criteria were 1) acute symptomatic ICAO within 6 hours of symptom onset, 2) attempted endovascular revascularization, and 3) enabled 3 months follow-up. Factor associated good outcome (modified Rankin scale score 0-2) at 3 months were evaluated including collateral grading, which was assessed with the ASITN/SIR Collateral Flow Grading System on pre-treatment angiography. A score of grade 0-1 was designated as poor, grade 2-3 as good collateral flow (no patients with ICAO showed grade 4 collateral). Results: During 8 year study period, total 80 patients were enrolled , good collateral flow was shown in 35 patients (44%) and poor collateral in 45 (56%). The patients with good collateral had lower National Institute of Health Stroke Scale (NIHSS) score comparing with poor collateral (15 ± 5 vs. 18 ± 4, p = 0.008) and less frequently suffered symptomatic intracranial hemorrhage (14% vs. 40%, p = 0.02). Multivariate analysis revealed that good collateral flow before treatments [OR 6.77, 95% CI, 1.12-41.05] and complete recanalization after treatments [OR 9.18, 95% CI, 1.13-74.04] were independent predictors of good outcome at 3 months. Whereas, higher NIHSS score were strong predictor of poor outcome [OR 0.74, 95% CI, 0.577-0.95] after adjusting age, sex, onset-to-treatment time, parenchymal hematoma, initial glucose and systolic blood pressure. Conclusions: In acute symptomatic carotid artery occlusion, the patient with initial good collateral flow with less severe neurological deficit and subsequent complete recanalization had higher chance of good outcome. To avoid futile recanalization in ICAO, collateral assessment and achieving complete recanalization might be important.