Géraud Forestier1,2, Rémi Agbonon3, Nicolas Bricout4, Wagih Benhassen3, Guillaume Turc5, Martin Bretzner4,6, Marco Pasi7, Joseph Benzakoun3, Pierre Seners5, Thomas Personnic7, Laurence Legrand3, Denis Trystram3, Christine Rodriguez-Regent3, Andreas Charidimou6, Natalia S Rost6, Serge Bracard8, Frédéric Clarençon9, Omer F Eker10, Norbert Nighoghossian11, Charlotte Cordonnier7, Catherine Oppenheim3, Olivier Naggara3, Hilde Henon7, Grégoire Boulouis3. 1. Neuroradiology Department, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris Descartes University, Paris, France. geraudforestier@gmail.com. 2. Neuroradiology Department, Dupuytren, University Hospital of Limoges, 2 Avenue Martin Luther-King, 87042, Limoges, France. geraudforestier@gmail.com. 3. Neuroradiology Department, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris Descartes University, Paris, France. 4. Neuroradiology Department, Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neurosciences and Cognition, 59000, Lille, France. 5. Neurology Department, INSERM U1266, DHU Neurovasculaire, Sainte-Anne Hospital, Paris Descartes University, Paris, France. 6. Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. 7. Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, 59000, Lille, France. 8. Department of Diagnostic and Interventional Neuroradiology, Inserm, IADI, CHRU Nancy, Université de Lorraine, Nancy, France. 9. Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, Île-de-France, France. 10. Department of Neuroradiology of Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France. 11. Stroke Department, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France.
Abstract
BACKGROUND AND PURPOSE: To determine the influence of the cerebral small vessel disease (SVD) burden on collateral recruitment in patients treated with mechanical thrombectomy (MT) for anterior circulation acute ischemic stroke (AIS). METHODS: Patients with AIS due to large vessel occlusion (LVO) from the Thrombectomie des Artères Cérébrales (THRACE) trial and prospective cohorts from 2 academic comprehensive stroke centers treated with MT were pooled and retrospectively analyzed. Collaterals' adequacy was assessed using the American Society of Interventional and Therapeutic Radiology/Society of Interventional Radiology (ASITN/SIR) score on initial digital subtraction angiography and dichotomized as good (3,4) versus poor (0-2) collaterals. The SVD burden was rated with the global SVD score on MRI. Multivariable logistic regression analyses were used to determine relationships between SVD and ASITN/SIR scores. RESULTS: A total of 312 participants were included (53.2% males, mean age 67.8 ± 14.9 years). Two hundred and seven patients had poor collaterals (66.4%), and 133 (42.6%) presented with any SVD signature. In multivariable analysis, patients demonstrated worse leptomeningeal collaterality with increasing SVD burden before and after adjustment for SVD risk factors (adjusted odds ratio [aOR] 0.69; 95%CI [0.52-0.89] and aOR 0.66; 95%CI [0.5-0.88], respectively). Using individual SVD markers, poor collaterals were significantly associated with the presence of lacunes (aOR 0.40, 95% CI [0.20-0.79]). CONCLUSION: Our study provides evidence that in patients with AIS due to LVO treated with MT, the burden of SVD assessed by pre-treatment MRI is associated with poorer recruitment of leptomeningeal collaterals.
BACKGROUND AND PURPOSE: To determine the influence of the cerebral small vessel disease (SVD) burden on collateral recruitment in patients treated with mechanical thrombectomy (MT) for anterior circulation acute ischemic stroke (AIS). METHODS: Patients with AIS due to large vessel occlusion (LVO) from the Thrombectomie des Artères Cérébrales (THRACE) trial and prospective cohorts from 2 academic comprehensive stroke centers treated with MT were pooled and retrospectively analyzed. Collaterals' adequacy was assessed using the American Society of Interventional and Therapeutic Radiology/Society of Interventional Radiology (ASITN/SIR) score on initial digital subtraction angiography and dichotomized as good (3,4) versus poor (0-2) collaterals. The SVD burden was rated with the global SVD score on MRI. Multivariable logistic regression analyses were used to determine relationships between SVD and ASITN/SIR scores. RESULTS: A total of 312 participants were included (53.2% males, mean age 67.8 ± 14.9 years). Two hundred and seven patients had poor collaterals (66.4%), and 133 (42.6%) presented with any SVD signature. In multivariable analysis, patients demonstrated worse leptomeningeal collaterality with increasing SVD burden before and after adjustment for SVD risk factors (adjusted odds ratio [aOR] 0.69; 95%CI [0.52-0.89] and aOR 0.66; 95%CI [0.5-0.88], respectively). Using individual SVD markers, poor collaterals were significantly associated with the presence of lacunes (aOR 0.40, 95% CI [0.20-0.79]). CONCLUSION: Our study provides evidence that in patients with AIS due to LVO treated with MT, the burden of SVD assessed by pre-treatment MRI is associated with poorer recruitment of leptomeningeal collaterals.
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