Abstract
Background: The interplay between collateral status and stroke aetiology may be crucial in the evaluation and management of acute ischemic stroke (AIS). Our understanding of this relationship and its level of association remains sub-optimal. This study sought to examine the association of pre-intervention collateral status with stroke aetiology, specifically large artery atherosclerosis (LAA) and cardio-embolism (CE), in AIS patients receiving reperfusion therapy, by performing a meta-analysis. Methods: Relevant search terms were explored on Medline/PubMed, Embase and Cochrane databases. Studies were included using the following inclusion criteria: (a) patients aged 18 or above; (b) AIS patients; (c) patients receiving reperfusion therapy; (d) total cohort size of >20, and (e) qualitative or quantitative assessment of pre-intervention collateral status on imaging using a grading scale. Random-effects meta-analysis was performed to investigate the association of aetiology with pre-intervention collateral status, and forest plots of risk ratio (RR) were generated. Results: A meta-analysis was conducted on seven studies, with a cumulative cohort of 1235 patients, to assess the association of pre-intervention collateral status with stroke aetiology. Patients with LAA were associated significantly with an increased rate of good collaterals (RR 1.24; 95% CI 1.04–1.50; p = 0.020, z = 2.33). Contrarily, CE aetiology was associated significantly with a decreased rate of good collaterals (RR 0.83; 95% CI 0.71–0.98; p = 0.027, z = −2.213). Conclusions: This study demonstrates that, in AIS patients receiving reperfusion therapy, LAA and CE aetiologies are associated significantly with collateral status.
Highlights
Pre-intervention cerebral collateral status is an important consideration in the acute ischemic stroke (AIS) workup [1]
Studies published in the English language investigating the impact of pre-intervention collateral status on AIS patients receiving RT with either large artery atherosclerosis (LAA) or CE as their stroke aetiology were reviewed on PubMed/Medline, Embase and the Cochrane Central Register of Controlled Trials for the period from January 2005 to June 2021
The following data were extracted from all included studies: (a) study details: author, title, year and country of publication; (b) patient demographics: cohort size in treatment and control groups, age and co-morbidities/risk factors; (c) pre-intervention collateral status; (d) stroke aetiology of LAA or CE
Summary
Pre-intervention cerebral collateral status is an important consideration in the acute ischemic stroke (AIS) workup [1]. The current clinical assessment of stroke harnesses standardised methods, such as Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Causative Classification of Stroke (CCS), to delineate the underlying aetiology [6]. These methods remain suboptimal and further avenues to refine aetiology assessment in stroke patients could be useful. This study sought to investigate the association of stroke aetiology, LAA vs CE, with pre-intervention collateral status (good vs poor) in AIS patients receiving reperfusion therapy (RT), systemic thrombolysis (using tissue plasminogen activator (tPA)) and/or endovascular thrombectomy (EVT), by performing a meta-analysis. The underlying question was, in AIS patients receiving RT: Is stroke aetiology, LAA or CE, associated with pre-intervention collateral status?
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