Impact of Collaterals on Successful Revascularization in Solitaire FR With the Intention for Thrombectomy

被引:172
作者
Liebeskind, David S. [1 ]
Jahan, Reza [1 ]
Nogueira, Raul G. [2 ]
Zaidat, Osama O. [3 ]
Saver, Jeffrey L. [1 ]
机构
[1] UCLA Stroke Ctr, Los Angeles, CA 90095 USA
[2] Emory Univ, Sch Med, Atlanta, GA USA
[3] Froedtert Hosp, Med Coll Wisconsin, Milwaukee, WI USA
基金
美国国家卫生研究院;
关键词
collaterals; endovascular therapy; stroke; revascularization; ACUTE ISCHEMIC-STROKE; FLOW RESTORATION; RECOMMENDATIONS; THROMBOLYSIS; CIRCULATION; STANDARDS;
D O I
10.1161/STROKEAHA.114.004781
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Collaterals at angiography before endovascular therapy were analyzed to ascertain the effect on a novel end point of successful revascularization without symptomatic hemorrhage in the Solitaire FR With the Intention for Thrombectomy (SWIFT) study. Methods-Collateral grade (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology) on baseline angiography was independently assessed, blind to other data, with statistical analyses delineating the relationship with clinical, laboratory, and imaging parameters. Results-Angiographic data on collaterals were available in 119 of 144 subjects (mean age, 67 +/- 12 years; 52% woman; median National Institutes of Health Stroke Scale, 18 [range, 8-28]). Worse collaterals were noted in subjects with elevated baseline blood glucose (P=0.013) and those with elevated baseline systolic blood pressure (P=0.039). Multivariate predictors of partial or worse collaterals included absence of prior hypertension (odds ratio, 4.049, P=0.012), smoking history (odds ratio, 3.822; P=0.013), and higher blood glucose (odds ratio, 1.017; P=0.022). Collaterals were strongly related to Alberta Stroke Program Early CT Score (ASPECTS) at baseline (0-1: median 8 [3-10]; 2-9 [5-10]; 3-9 [7-10]; 4-9 [8-10]; P<0.001) and 24 hours (0-1: median 1 [0-5]; 2-6 [0-10]; 3-8 [0-10]; 4-8 [4-8]; P<0.001). Better collaterals were linked with Thrombolysis in Cerebral Infarction 2b/3 reperfusion (P=0.019), better median National Institutes of Health Stroke Scale at day 7/discharge (P<0.001), and better day 90 modified Rankin Scale (P<0.001). Better collateral grade was associated with successful revascularization without symptomatic hemorrhage, mean 2.3 (95% confidence interval, 2.1-2.5) versus 1.9 (95% confidence interval, 1.7-2.2), P=0.021. Conclusions-Better collaterals were associated with lower glucose, lower blood pressure, smaller baseline infarcts in SWIFT, and greater likelihood of successful revascularization without hemorrhage and good clinical outcomes.
引用
收藏
页码:2036 / 2040
页数:5
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