Associations Between Collateral Status and Thrombus Characteristics and Their Impact in Anterior Circulation Stroke

Alves, Heitor; Treurniet, Kilian M.; Dutra, Bruna Garbugio; Jansen, Ivo G. H.; Boers, Anna M. M.; Santos, Emilie M. M.; Berkhemer, Olvert A.; Dippel, Diederik W.J.; Lugt, Aad van der; Zwam, Wim H. van; Oostenbrugge, Robert J. van; Lingsma, Hester F.; Roos, Yvo B.W.E.M.; Yoo, Albert J.; Marquering, Henk A.; Majoie, Charles B. L. M.

doi:10.1161/strokeaha.117.019509

Cited by 45 publications

(32 citation statements)

References 36 publications

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“…Good pial or leptomeningeal collateral circulation predicts better clinical responses to intra-arterial treatment even 5 hours after the onset of the stroke, suggesting that collateral status could extend the time window for endovascular procedures (Ribo et al, 2011). Therefore, collateral flow to penumbral tissue beyond the clot has clinical implications in the setting of acute endovascular therapy (Hwang et al .,2015) The findings of the present study are in accordance with those of Alves et al, (2018) who stated that collateral scores are associated with thrombus characteristics in which the patients with higher collateral scores had lower thrombus burden. The association between clot burden score and MRS score seems to be partially explained by lower clot burden score leading to higher collateral score.…”

Section: Figuressupporting

confidence: 88%

Assessment of Cerebral Collaterals in Acute Ischemic Stroke by CT Cerebral Angiography and Its Relation to the Functional Outcome

et al. 2019

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Section: Figuressupporting

confidence: 88%

Assessment of Cerebral Collaterals in Acute Ischemic Stroke by CT Cerebral Angiography and Its Relation to the Functional Outcome

et al. 2019

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“…Several methods, including CTA (Sundaram et al, ; Yeo et al, ) and MR (Alves et al, ), have been established to evaluate collateral status. Although CTA is highly accurate in the assessment of anatomical variations of Willis' circle, its sensitivity remains limited in its ability to reveal hypoplastic segments (Han et al, ), and time‐of‐flight (TOF) MRA has disadvantages in a setting involving slow flow at the site of occlusion, which often results in complete loss of the signal in arteries and the consequential underestimation of collateral status (Raymond & Schaefer, ).…”

Section: Discussionmentioning

confidence: 99%

“…A similar finding was presented in Silvestrini et al (2011), in which the preservation of at least two activated intracranial collateral vessels (the ophthalmic artery, AcoA or PcoA) produced a significant trend toward favorable outcomes in patients with internal carotid artery occlusion due to dissection. Several methods, including CTA (Sundaram et al, 2017;Yeo et al, 2015) and MR (Alves et al, 2018), have been established to evaluate collateral status. Although CTA is highly accurate in the assessment of anatomical variations of Willis' circle, its sensitivity remains limited in its ability to reveal hypoplastic segments (Han et al, 2011), and time-of-flight (TOF) MRA has disadvantages in a setting involving slow flow at the site of occlusion, which often results in complete loss of the signal in arteries and the consequential underestimation of collateral status (Raymond & Schaefer, 2017).…”

Section: Discussionmentioning

confidence: 99%

Collateral grade of the Willis' circle predicts outcomes of acute intracranial internal carotid artery occlusion before thrombectomy

Zhao

Wang²,

et al. 2019

Brain and Behavior

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Background and PurposeEndovascular mechanical thrombectomy (EVMT) shows significant promise in improving acute ischemic stroke (AIS) with proximal artery occlusion, but outcomes have been variable. We explored the patients treated by thrombectomy to investigate the association between a favorable clinical outcome of EVMT in intracranial internal carotid artery occlusion (iICAO) and a set of predictors.MethodsA total of 38 iICAO patients treated by EVMTs were analyzed. Primary collateral grades (PCG) at baseline based on the integrity of Willis' circle were categorized into three degrees. The favorable outcomes, measured by modified Rankin scale (mRS), were defined as ≤2 at 90 days. The reperfusion was one of the most important confounders, defined as modified thrombolysis in cerebral infarction (mTICI) ≥ 2b. The other risk factors included demographic characteristics, vascular risk factors, stroke severity, procedural EVMT, and PCG at baseline was adjusted to reveal the association with favorable outcomes.ResultsOf 38 iICAO patients, 65.8% (25 in 38) achieved reperfusion. However, only 31.6% (12/38) achieved favorable outcomes at 90 days. With a PCG3, 61.5% of them achieved favorable outcomes, while only 37.5% of those with PCG2 and PCG1 achieved favorable outcomes (p = .003). In multivariable logistic regression, PCG was revealed as a predictor for favorable outcomes (OR 5.278, p = .019) after adjusting the reperfusion and other factors.ConclusionsThe PCG based on the integrity of Willis' circle might be an underlying predictor of the prognosis of AIS in patients with iICAO after EVMT. The function of intact anterior communicating artery (AcoA) and ipsilateral posterior communicating artery (PcoA) in favoring prognosis of the iICAO patients might need to be validation in future study.

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“…The studies had proved that vulnerability of intracranial artery plaque and hypoperfusion of blood flow at the distal stenotic site were highly associated with stroke events and recurrence [10][11]. Anterior circulation acute ischemic stroke study had proved the associations between collateral circulation and thrombus characteristics, that patients with higher collateral scores had lower thrombus burden and more previous thrombi [12][13].…”

Section: Introductionmentioning

confidence: 99%

Association Between Basilar Artery Configuration and Vessel Wall Features: A Prospective High-resolution Magnetic Resonance Imaging Study

Hou

et al. 2019

Preprint

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Background The relationship between intracranial vessel configuration and wall features remains poorly investigated. Therefore, we aimed to investigate the relationship between the distal and proximal anatomical configuration of basilar artery (BA) and BA vessel wall features on high-resolution magnetic resonance imaging (HRMRI) . Methods From September 2014 to January 2017, patients with suspected symptomatic intracranial arterial stenosis underwent HRMRI. Patients with severe BA stenosis were selected for this prospective study and divided into two groups corresponding to complete and incomplete BA configuration based on characteristics of the bilateral vertebral arteries and posterior cerebral arteries. Culprit blood vessel wall features on HRMRI included plaque enhancement, intraplaque hemorrhage, remodeling patterns, and plaque distribution. Culprit vessel wall features were compared between patients in the complete and incomplete BA configuration groups. Results Among the 298 consecutively enrolled patients, 34 had severe BA stenosis. 20 patients had complete anatomical BA configuration and another 14 of them displayed incomplete configuration. There were no significant differences in vessel wall features between the complete and incomplete configuration patient groups. However, the proximal configuration of BA was associated with intraplaque hemorrhage (p=0.002) while the distal configuration of BA correlated with strong enhancement of BA plaque (p=0.041). Conclusions No association was found between the complete and incomplete BA configuration groups and blood vessel wall features. The proximal configuration of BA was related with intraplaque hemorrhage and the distal configuration of BA was associated with strong plaque enhancement. Further studies are warranted to confirm these findings. Trial Registration : URL: http://www.clinicaltrials.gov. Unique identifier: NCT02705599 (March 10, 2016).

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Associations Between Collateral Status and Thrombus Characteristics and Their Impact in Anterior Circulation Stroke

Abstract: URL: http://www.trialregister.nl. Unique identifier: NTR1804 and URL: http://www.controlled-trials.com Unique identifier: ISRCTN10888758.

Cited by 45 publications

References 36 publications

Assessment of Cerebral Collaterals in Acute Ischemic Stroke by CT Cerebral Angiography and Its Relation to the Functional Outcome

Assessment of Cerebral Collaterals in Acute Ischemic Stroke by CT Cerebral Angiography and Its Relation to the Functional Outcome

Collateral grade of the Willis' circle predicts outcomes of acute intracranial internal carotid artery occlusion before thrombectomy

Association Between Basilar Artery Configuration and Vessel Wall Features: A Prospective High-resolution Magnetic Resonance Imaging Study

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