Oliver C Singer1, Joachim Berkefeld, Christian H Nolte, Georg Bohner, Arno Reich, Martin Wiesmann, Klaus Groeschel, Stephan Boor, Tobias Neumann-Haefelin, Erich Hofmann, Anett Stoll, Albrecht Bormann, David S Liebeskind. 1. From the Department of Neurology (O.C.S.) and Institute for Neuroradiology (J.B.), Goethe University, Schleusenweg 2-16, D-60528 Frankfurt/Main, Germany; Department of Neurology (C.H.N.) and Institute for Diagnostic and Interventional Radiology and Nuclear Medicine (G.B.), Charité Hospital, Berlin, Germany; Department of Neurology (A.R.) and Institute for Diagnostic and Interventional Neuroradiology (M.W.), University Hospital Aachen, Aachen, Germany; Department of Neurology (K.G.) and Institute for Neuroradiology (S.B.), University Hospital Mainz, Mainz, Germany; Department of Neurology (T.N.) and Institute for Diagnostic and Interventional Neuroradiology (E.H.), Klinikum Fulda, Fulda, Germany; Department of Neurology (A.S.) and Institute for Radiology (A.B.), Klinikum Altenburger Land, Altenburg, Germany; and UCLA Stroke Center and Department of Neurology, University of California-Los Angeles, Los Angeles, Calif (D.S.L.).
Abstract
PURPOSE: To determine the impact of collateral vessel status on clinical and imaging outcomes in patients undergoing endovascular therapy (EVT) for proximal middle cerebral artery (MCA) occlusion. MATERIALS AND METHODS: There were 160 patients with proximal MCA occlusion at six centers in this institutional review board-approved multicenter EVT registry. Angiograms were analyzed at a blinded core laboratory, and collateral vessel status was assessed by using the American Society of Interventional and Therapeutic Neuroradiology (ASITN)/Society of Interventional Radiology (SIR) collateral vessel grading system, while reperfusion was assessed by using the Thrombolysis in Cerebral Infarction (TICI) scale. Good outcome was defined as a modified Rankin Scale score of 0-2 at follow-up. Binary logistic regression analysis was performed by using parameters with P < .2 in univariate analysis. RESULTS: Good clinical outcome was attained in 62 (39%) of the 160 patients, and TICI 2b-3 reperfusion was achieved in 94 (59%) patients. Nineteen patients had ASITN/SIR collateral vessel grades of 0 or 1, 63 patients had a grade of 2, and 78 patients had grades of 3 or 4. Better collateral vessels were associated with higher reperfusion rates (21%, 48%, and 77% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P < .001), a higher proportion of infarcts smaller than one-third of the MCA territory (32%, 48%, and 69% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P < .001), and a higher proportion of good clinical outcome (11%, 35%, and 49% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P = .007). At multivariable analysis, collateral vessel status independently predicted reperfusion, final infarct size, and clinical outcome. Within an onset-to-treatment time (OTT) of 0-3 hours, collateral vessel status predicted final infarct size and reperfusion. Within an OTT of 3-6 hours, it additionally predicted clinical outcome, with 53% of patients with ASITN/SIR grades of 3 or 4 having a good outcome, as compared with 0% of patients with grades of 0 or 1 and 27% of patients with a grade of 2 (P = .008). CONCLUSION: In this patient population, collateral vessel status independently predicted the pivotal outcome parameters of reperfusion, infarct size, and clinical outcome. These data underscore the utility of patient selection for EVT on the basis of collateral vessel status.
PURPOSE: To determine the impact of collateral vessel status on clinical and imaging outcomes in patients undergoing endovascular therapy (EVT) for proximal middle cerebral artery (MCA) occlusion. MATERIALS AND METHODS: There were 160 patients with proximal MCA occlusion at six centers in this institutional review board-approved multicenter EVT registry. Angiograms were analyzed at a blinded core laboratory, and collateral vessel status was assessed by using the American Society of Interventional and Therapeutic Neuroradiology (ASITN)/Society of Interventional Radiology (SIR) collateral vessel grading system, while reperfusion was assessed by using the Thrombolysis in Cerebral Infarction (TICI) scale. Good outcome was defined as a modified Rankin Scale score of 0-2 at follow-up. Binary logistic regression analysis was performed by using parameters with P < .2 in univariate analysis. RESULTS: Good clinical outcome was attained in 62 (39%) of the 160 patients, and TICI 2b-3 reperfusion was achieved in 94 (59%) patients. Nineteen patients had ASITN/SIR collateral vessel grades of 0 or 1, 63 patients had a grade of 2, and 78 patients had grades of 3 or 4. Better collateral vessels were associated with higher reperfusion rates (21%, 48%, and 77% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P < .001), a higher proportion of infarcts smaller than one-third of the MCA territory (32%, 48%, and 69% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P < .001), and a higher proportion of good clinical outcome (11%, 35%, and 49% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P = .007). At multivariable analysis, collateral vessel status independently predicted reperfusion, final infarct size, and clinical outcome. Within an onset-to-treatment time (OTT) of 0-3 hours, collateral vessel status predicted final infarct size and reperfusion. Within an OTT of 3-6 hours, it additionally predicted clinical outcome, with 53% of patients with ASITN/SIR grades of 3 or 4 having a good outcome, as compared with 0% of patients with grades of 0 or 1 and 27% of patients with a grade of 2 (P = .008). CONCLUSION: In this patient population, collateral vessel status independently predicted the pivotal outcome parameters of reperfusion, infarct size, and clinical outcome. These data underscore the utility of patient selection for EVT on the basis of collateral vessel status.
Authors: Juan F Arenillas; Elisa Cortijo; Pablo García-Bermejo; Elad I Levy; Reza Jahan; David Liebeskind; Mayank Goyal; Jeffrey L Saver; Gregory W Albers Journal: J Cereb Blood Flow Metab Date: 2017-11-14 Impact factor: 6.200
Authors: I R van den Wijngaard; G Holswilder; M J H Wermer; J Boiten; A Algra; D W J Dippel; J W Dankbaar; B K Velthuis; A M M Boers; C B L M Majoie; M A A van Walderveen Journal: AJNR Am J Neuroradiol Date: 2016-03-31 Impact factor: 3.825
Authors: J Pfaff; C Herweh; M Pham; S Schieber; P A Ringleb; M Bendszus; M Möhlenbruch Journal: AJNR Am J Neuroradiol Date: 2015-11-05 Impact factor: 3.825
Authors: I Derraz; M Pou; J Labreuche; L Legrand; S Soize; M Tisserand; C Rosso; M Piotin; G Boulouis; C Oppenheim; O Naggara; S Bracard; F Clarençon; B Lapergue; R Bourcier Journal: AJNR Am J Neuroradiol Date: 2020-11-12 Impact factor: 3.825