Abstract
Background Successful mechanical thrombectomy (MT) requires reliable, noninvasive selection criteria. We aimed to investigate the association of collateral status and clinical outcomes after MT in patients with ischemic stroke due to anterior circulation occlusion. Methods 109 patients with poor collaterals and 110 aged, sex-matched patients with good collaterals were enrolled in the study. Collateral circulation was estimated by the CT angiography with a 0–3 scale. The collateral status was categorized as poor collaterals (scores 0–1) and good collaterals (scores 2-3). The reperfusion was assessed by the modified Treatment in Cerebral Infarction scale (mTICI, score 0/1/2a/2b/3). The clinical outcomes included the scores on the modified Rankin scale (mRS, ranging from 0 to 6) and death 90 days after mechanical thrombectomy. Results Patients with greater scores of collateral status were more likely to achieve successful reperfusion (mTICI 2b/3). Patients with good collaterals were significantly associated with a higher chance of achieving mRS of 0–1 at 90 days (adjusted ORs: 4.55; 95% CI: 3.17–7.24; and P < 0.001) and a lower risk of death at 90 days (adjusted ORs: 0.87; 95% CI: 4.0%–28.0%; and P = 0.012) compared to patients with poor collaterals. In subgroup analyses, patients with statin use seem to benefit more from the effect of collateral status on good mRS (≤2). Conclusion Among patients with acute ischemic stroke caused by anterior circulation occlusion, better collateral status is associated with higher scores on mRS and lower mortality after mechanical thrombectomy. Statin use might have an interaction with the effect of collateral status.
Highlights
IntroductionThe stroke burden has increased in China, and ischemic stroke accounted for 69.6% of incident strokes and 77.8% of prevalent strokes in 2013 [1]
Over the past decades, the stroke burden has increased in China, and ischemic stroke accounted for 69.6% of incident strokes and 77.8% of prevalent strokes in 2013 [1]
No significant differences were found in history of atrial fibrillation, antiplatelet medication use, anticoagulant drug use, glucose at hospital arrival, time from stroke onset to intravenous alteplase, time from stroke onset to groin puncture, and time from stroke onset to revascularization between the two groups (Table 1)
Summary
The stroke burden has increased in China, and ischemic stroke accounted for 69.6% of incident strokes and 77.8% of prevalent strokes in 2013 [1]. Mechanical thrombectomy (MT) has been consistently demonstrated to be an effective treatment for patients after ischemic stroke of anterior circulation occlusion in prospective randomized trials [5,6,7]. E abovementioned evidence suggests that other factors may contribute to the clinical outcome of patients after anterior circulation occlusion in MT besides the time window. We aimed to investigate the association of collateral status and clinical outcomes after MT in patients with ischemic stroke due to anterior circulation occlusion. Patients with statin use seem to benefit more from the effect of collateral status on good mRS (≤2). Among patients with acute ischemic stroke caused by anterior circulation occlusion, better collateral status is associated with higher scores on mRS and lower mortality after mechanical thrombectomy. Statin use might have an interaction with the effect of collateral status
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