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Cerebrovascular disease
Research paper
Collateral status affects the onset-to-reperfusion time window for good outcome
  1. Byung Moon Kim1,
  2. Jang-Hyun Baek2,
  3. Ji Hoe Heo3,
  4. Hyo Suk Nam3,
  5. Young Dae Kim3,
  6. Joonsang Yoo4,
  7. Dong Joon Kim1,
  8. Pyoung Jeon5,
  9. Seung Kug Baik6,
  10. Sang Hyun Suh7,
  11. Kyung Yol Lee8,
  12. Hyo Sung Kwak9,
  13. Hong Gee Roh10,11,
  14. Young-Jun Lee12,
  15. Sang Heum Kim13,
  16. Chang-Woo Ryu14,
  17. Yon-Kwon Ihn15,
  18. Byungjoon Kim16,
  19. Hong Jun Jeon17,
  20. Jin Woo Kim18,
  21. Jun Soo Byun19,
  22. Sangil Suh20,
  23. Jeong Jin Park21,
  24. Woong Jae Lee22,
  25. Jieun Roh6,
  26. Byoung-Soo Shin23,
  27. Oh Young Bang24
  1. 1 Department of Radiology, Severance stroke center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
  2. 2 Department of Neurology, National Medical Center, Seoul, South Korea
  3. 3 Department of Neurology, Severance stroke center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
  4. 4 Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
  5. 5 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  6. 6 Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
  7. 7 Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, South Korea
  8. 8 Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
  9. 9 Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, South Korea
  10. 10 Department of Radiology, Konkuk University Medical Center, Seoul, South Korea
  11. 11 Konkuk University School of Medicine
  12. 12 Department of Radiology, Hanyang University College of Medicine and Hospital, Seoul, South Korea
  13. 13 Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
  14. 14 Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
  15. 15 Department of Radiology, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
  16. 16 Department of Radiology, Korea University Anam Hospital, Seoul, South Korea
  17. 17 Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
  18. 18 Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, South Korea
  19. 19 Department of Radiology, Chung-Ang University Hospital, Seoul, South Korea
  20. 20 Department of Radiology, Korea University College of Medicine, Guro Hospital, Seoul, South Korea
  21. 21 Department of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, South Korea
  22. 22 Department of Neurology, Hanyang University Medical School and Hospital, Seoul, South Korea
  23. 23 Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju, South Korea
  24. 24 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  1. Correspondence to Professor Byung Moon Kim, Interventional Neuroradiology, Department of Radiology, Severance stroke center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; bmoon21{at}hanmail.net

Abstract

Objective To characterise the time window in which endovascular thrombectomy (EVT) is associated with good outcome, and to test the differential relationship between functional outcome and onset-to-reperfusion time (ORT), depending on collateral status.

Methods This was a retrospective analysis of clinical and imaging data of 554 consecutive patients, who had recanalisation success by EVT for anterior circulation large artery occlusion, from the prospectively maintained registries of 16 comprehensive stroke centres between September 2010 and December 2015. The patients were dichotomised into good and poor collateral groups, based on CT angiography. We tested whether the likelihood of good outcome (modified Rankin Scale, 0–2) by ORT was different between two groups.

Results ORT was 298 min±113 min (range, 81–665 min), and 84.5% of patients had good collaterals. Age, diabetes mellitus, previous infarction, National Institutes of Health Stroke Scale, good collaterals (OR 40.766; 95% CI 10.668 to 155.78; p<0.001) and ORT (OR 0.926 every 30 min delay; 95% CI 0.862 to 0.995; p=0.037) were independently associated with good outcome. The drop in likelihood of good outcome associated with longer ORT was significantly faster in poor collateral group (OR 0.305 for every 30 min; 95% CI 0.113 to 0.822) than in good collateral group (OR 0.926 for every 30 min; 95% CI 0.875 to 0.980).

Conclusions Earlier successful recanalisation was strongly associated with good outcome in poor collateral group; however, this association was weak during the tested time window in good collateral group. This suggests that the ORT window for good outcome can be adjusted according to collateral status.

https://doi.org/10.1136/jnnp-2017-317627

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    Footnotes

    • Contributors BMK had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. BMK, HSN, JHH, JHB and OYB were involved in study concept and design. BMK, OYB and JHB were responsible for drafting a significant portion in the manuscript or figures. All authors were involved in the acquisition and analysis of data.

    • Funding This research was investigator initiated and supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare of the Republic of Korea (HC15C1056).

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval Severance Hospital Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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