Abstract
Introduction: Endovascular therapy (EVT) for the treatment of acute ischemic stroke in cervical and/or cerebral arterial occlusions is superior to standard medical therapy alone. This however requires careful patient selection and the current criteria utilising time windows and the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is imperfect, limiting its efficacy. We explore the impact of pretreatment collateral status (CS) in predicting EVT outcomes. Methods: A systematic literature search was conducted on PubMed and EMBASE for randomized controlled trials and prospective and retrospective cohort studies without language restriction from January 01, 2000 to June 25, 2019. We included studies reporting efficacy and safety outcomes dichotomised by collateral status in patients with acute anterior circulation ischemic stroke that were treated with mechanical thrombectomy and/or intra-arterial thrombolysis. Odds ratios were pooled for good versus poor collaterals for outcomes based on a random-effects model. Results: The search strategy yielded fifty-four (54) studies (n=7,599) (mean age 67.6 years; females 47.4%) for quantitative analysis, of which there were 2 pairs of studies with overlapping populations but had reported different outcomes. Thus, there were at least 7,441 unique individuals included in this analysis recruited between May 1992 and September 2018. Analysis showed that good CS was strongly associated with favourable functional outcomes (modified Rankin Scale 0-2) at discharge, as well as at 3 months or follow-up (Table 1). Good CS was also associated with higher revascularization rates, lower rates of mortality and lower rates of symptomatic intracranial hemorrhage. Conclusions: Good pretreatment CS strongly predicts good functional outcome and lower complication rates. Pretreatment CS should be considered in the design of future clinical trials and as a selection criteria for EVT.
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