Robust Collaterals Are Independently Associated With Excellent Recanalization in Patients With Large Vessel Occlusion Causing Acute Ischemic Stroke

被引：3

作者：

Yedavalli, Vivek ^{[1
]}

Koneru, Manisha ^{[2
]}

Hoseinyazdi, Meisam ^{[3
]}

Greene, Cynthia ^{[1
]}

Copeland, Karen ^{[4
]}

Xu, Risheng ^{[5
]}

Luna, Licia ^{[3
]}

Caplan, Justin ^{[5
]}

Dmytriw, Adam ^{[6
,7
]}

Guenego, Adrien ^{[8
]}

Heit, Jeremy ^{[9
]}

Albers, Gregory ^{[10
]}

Wintermark, Max ^{[11
]}

Gonzalez, Luis Fernando ^{[5
]}

Urrutia, Victor ^{[5
]}

Huang, Judy ^{[5
]}

Leigh, Richard ^{[1
]}

Marsh, Elisabeth ^{[12
]}

Llinas, Rafael ^{[12
]}

Hillis, Argye ^{[5
]}

Nael, Kambiz ^{[13
]}

机构：

[1] Johns Hopkins Univ, Baltimore, MD 21218 USA

[2] Rowan Univ, Cooper Med Sch, Baltimore, MD USA

[3] Johns Hopkins Univ Hosp, Baltimore, MD USA

[4] Boulder Stat, Steamboat Springs, CO USA

[5] Johns Hopkins Univ, Sch Med, Baltimore, MD 21218 USA

[6] Massachusetts Gen Hosp, Boston, MA USA

[7] Harvard Med Sch, Boston, MA USA

[8] ULB Hop Erasme, Palo Alto, CA USA

[9] Stanford Univ, Sch Med, Palo Alto, CA USA

[10] Stanford Stroke Ctr, Stanford, CA USA

[11] Univ Texas MD Anderson Canc Ctr, Stanford, TX USA

[12] Johns Hopkins Sch Med, Baltimore, MD USA

[13] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA USA

来源：

STROKE-VASCULAR AND INTERVENTIONAL NEUROLOGY | 2024年 / 4卷 / 01期

关键词：

MIDDLE CEREBRAL-ARTERY; INTERVENTIONAL MANAGEMENT; ENDOVASCULAR TREATMENT; CT ANGIOGRAPHY; THROMBECTOMY; OUTCOMES; 2B; REVASCULARIZATION; THROMBOLYSIS; GUIDELINES;

D O I：

10.1161/SVIN.123.001141

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background In patients with acute ischemic stroke secondary to large vessel occlusion, achieving modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 (excellent recanalization) over mTICI 2b is associated with improved functional outcomes. We aimed to determine pretreatment and interventional parameters that are independently associated with mTICI 2c/3 over 2b reperfusion in patients who underwent technically successful mechanical thrombectomy. Methods In this retrospective study, consecutive patients with acute ischemic stroke with anterior circulation large vessel occlusion achieving mTICI 2b/2c/3 recanalization after mechanical thrombectomy were included. We evaluated the association between pretreatment clinical, imaging, and interventional parameters in patients who achieved mTICI 2c/3 versus 2b using multivariate logistic regressions. Results From May 11, 2019 to October 9, 2022, 149 consecutive patients met our inclusion criteria (median 70 years old [interquartile range 65-78.5], 57.7% female). Adjusted multivariate regression analyses showed that patients with excellent recanalization had lower admission National Institutes of Health Stroke Scale scores (adjusted odds ratio [aOR], 0.93; P=0.036), were less likely to have a history of diabetes (aOR, 0.42; P=0.050) and prior stroke (aOR, 0.27; P=0.007), had a cerebral blood volume index >= 0.7 (aOR, 3.75; P=0.007), and were more likely to achieve excellent recanalization with aspiration alone (aOR, 2.89; P=0.012). A multivariate logistic regression model comprising these independent factors predicted mTICI 2c/3 with an area under the curve 0.79 (95% CI, 0.68-0.86; P<0.001), sensitivity of 94%, and specificity of 41%. Conclusion Robust collateral status defined by cerebral blood volume index >= 0.7 on pretreatment computed tomography perfusion, absence of prior stroke, and absence of diabetes are independently associated with excellent recanalization in patients with successfully recanalized acute ischemic stroke-large vessel occlusion. Our findings highlight the prognostic implications of robust collateral status and modifiable risk factors that may influence collateral status for maximizing the likelihood of excellent recanalization.

引用

页数：9