Collateral status affects the onset-to-reperfusion time window for good outcome

Abstract

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.

NCCT and CTA-based imaging protocol for endovascular treatment selection in late presenting or wake-up strokes

“…For patients with LPS, poor collateralization—a marker of fast infarct growth30—is indicative of a high likelihood that the ischemic lesion is already completely established, and it has been clearly associated with poor outcomes even with successful recanalization 31. In our study, the proportion of patients with favorable collateral status in the group treated within 6 hours was similar to the WUS/LPS group.…”

Impact of coronary collateralization on long-term clinical outcomes in type 2 diabetic patients after successful recanalization of chronic total occlusion

“…Importantly, good collaterals in majority of patients will be rapidly subside after successful recanalization of a CTO, as antegrade blood flow is re-established and resistance is increased in the collateral vessels 36,40 . Kim et al found that good collateral circulation for myocardial protection only exists before recanalization forms an effective perfusion 41 . In addition, previous studies suggest that the occurrence of in-stent restenosis after successful CTO-PCI is not influenced by coronary collateralization 30 or even elevated in patients with good collaterals 42 .…”

Collateral status as the fifth dimension: warping the time clock for endovascular treatment in acute ischaemic stroke

“…This study4 did not provide data regarding pretreatment infarct core and penumbra or their changes over time by collateral status, which might illustrate directly the protective effect of collateral circulation in maintaining partial perfusion in arterial occlusion so that late-presenting patients would have the chance to achieve a good functional outcome after EVT. Another issue is the lack of a well-validated, non-invasive method to grade the collateral circulation in relevant studies or in clinical practice—various modalities or methods are being used.…”

“…In their  JNNP  paper Kim et al 4 recruited in routine clinical practice a large cohort of patients successfully revascularised with EVT for anterior circulation large artery occlusive stroke, with the onset-to-puncture time ≤600 min. Collateral status was dichotomised as good or poor on single-phase or multi-phase CT angiography.…”

“…This study recruited patients in 2010–2015,4 contemporary with trials in HERMES,1 while the findings were echoed in the most recent DAWN (Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention With Trevo)5 and DEFUSE 3 (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution)6 trials. DAWN and DEFUSE 3 have demonstrated that with deficit–imaging mismatch or presence of salvageable tissue, preserved by collateral circulation, patients could benefit from EVT up to 24 hours after onset over standard medical treatment 5 6…”