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Original research
Favourable arterial, tissue-level and venous collaterals correlate with early neurological improvement after successful thrombectomy treatment of acute ischaemic stroke
  1. Tobias Djamsched Faizy1,
  2. Michael Mlynash2,
  3. Reza Kabiri1,3,
  4. Soren Christensen2,
  5. Gabriella Kuraitis3,
  6. Lukas Meyer1,
  7. Matthias Bechstein1,
  8. Noel Van Horn1,
  9. Maarten G Lansberg2,
  10. Greg Albers2,
  11. Jens Fiehler4,
  12. Max Wintermark3,
  13. Jeremy J Heit5
  1. 1Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  2. 2Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
  3. 3Department of Radiology, Stanford University, Stanford, California, USA
  4. 4Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
  5. 5Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Jeremy J Heit, Department of Radiology, Stanford University School of Medicine, Stanford, USA; jheit{at}stanford.edu

Abstract

Background and purpose Early neurological improvement (ENI) after thrombectomy is associated with better long-term outcomes in patients with acute ischaemic stroke due to large vessel occlusion (AIS-LVO). Whether cerebral collaterals influence the likelihood of ENI is poorly described. We hypothesised that favourable collateral perfusion at the arterial, tissue-level and venous outflow (VO) levels is associated with ENI after thrombectomy.

Materials and methods Multicentre retrospective study of patients with AIS-LVO treated by thrombectomy. Tissue-level collaterals (TLC) were measured on cerebral perfusion studies by the hypoperfusion intensity ratio. VO and pial arterial collaterals (PAC) were determined by the Cortical Vein Opacification Score and the modified Tan scale on CT angiography, respectively. ENI was defined as improvement of ≥8 points or a National Institutes of Health Stroke Scale score of 0 hour or 1 24 hours after treatment. Multivariable regression analyses were used to determine the association of collateral biomarkers with ENI and good functional outcomes (modified Rankin Scale 0–2).

Results 646 patients met inclusion criteria. Favourable PAC (OR: 1.9, CI 1.2 to 3.1; p=0.01), favourable VO (OR: 3.3, CI 2.1 to 5.1; p<0.001) and successful reperfusion (OR: 3.1, CI 1.7 to 5.8; p<0.001) were associated with ENI, but favourable TLC were not (p=0.431). Good functional outcomes at 90-days were associated with favourable TLC (OR: 2.2, CI 1.4 to 3.6; p=0.001), VO (OR: 5.7, CI 3.5 to 9.3; p<0.001) and ENI (OR: 5.7, CI 3.3 to 9.8; p<0.001), but not PAC status (p=0.647).

Conclusion Favourable PAC and VO were associated with ENI after thrombectomy. Favourable TLC predicted longer term functional recovery after thrombectomy, but the impact of TLC on ENI is strongly dependent on vessel reperfusion.

  • stroke
  • vascular surgery
  • neuroradiology
  • neurosurgery
  • cerebral blood flow

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Footnotes

  • Twitter @JeremyHeitMDPHD

  • Contributors The authors of this study contributed as follows: TDF: study design and conceptualisation. Acquisition of the data. Image processing. Image analysis. Data analysis. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. MM: Acquisition of the data. Data analysis. Statistical supervisor and statistical analysis. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. RK: Study design and conceptualisation. Acquisition of the data. Image processing. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. SC: study design and conceptualisation. Acquisition of the data. Image processing. Image analysis. Data analysis. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. GK: Acquisition of the data. Image processing. Data analysis. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. LM: data analysis. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. MB: data analysis. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. NvH: Data analysis. Data interpretation. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. MGL: data interpretation. Supervision. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. GA: conceptualisation of the study. Data interpretation. Supervision. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. JF: Data interpretation. Supervision. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. MW: Conceptualisation of the study. Data interpretation. Supervision. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. JJH: study design and conceptualisation. Acquisition of the data. Image processing. Image analysis. Data analysis. Supervision. Drafting the manuscript and revising it critically. Approving a final version of the manuscript to be published. Guarantor of the entire study.

  • Funding TDF was funded by the German Research Foundation (DFG) for his work as a postdoctoral research scholar at Stanford University, Department of Neuroradiology (Project Number: 411621970).

  • Competing interests GA reports equity and consulting for iSchemaView and consulting from Medtronic. SC reports personal fees from iSchemaView outside the submitted work. JF reports grants and personal fees from Acandis, Cerenovus, MicroVention, Medtronic, Stryker, Phenox and grants from R92 outside the submitted work. MW reports grants and fundings from the NIH under the grant numbers (1U01 NS086872-01, 1U01 NS087748-01 and 1R01 NS104094). JJH reports consulting for Medtronic and MicroVention and Medical and Scientific Advisory Board membership for iSchemaView.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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