Collateral status reperfusion and outcomes after endovascular therapy: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) Registry

Anadani, Mohammad; Finitsis, Stephanos; Clarençon, Frédéric; Richard, Sébastien; Marnat, Gaultier; Bourcier, Romain; Sibon, Igor; Dargazanli, Cyril; Arquizan, Caroline; Blanc, Raphaël; Lapergue, Bertrand; Consoli, Arturo; Eugène, François; Vannier, Stéphane; Spelle, Laurent; Denier, Christian; Boulanger, Marion; Gauberti, Maxime; Liebeskind, David S; Havenon, Adam de; Saleme, Suzana; Macian, Francisco; Rosso, Charlotte; Naggara, Olivier; Turc, Guillaume; Ozkul-Wermester, Ozlem; Papagiannaki, Chrisanthi; Viguier, Alain; Cognard, Christophe; Bras, Anthony Le; Evain, Sarah; Wolff, Valérie; Pop, Raoul; Timsit, Serge; Gentric, Jean‐Christophe; Bourdain, Frédéric; Veunac, Louis; Maïer, Benjamin; Gory, Benjamin

doi:10.1136/neurintsurg-2021-017553

Cited by 26 publications

(24 citation statements)

References 25 publications

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“…Multiphase CT angiography (mCTA) plays an important role in the localisation of occlusion as well as in the evaluation of spatial and temporal profile of the collateral status and its patency [ 1 , 37 ]. Rapid assessment of collateral circulation downstream of occlusion is of value in the selection of candidates for EVT [ 38 ]. Whilst qualitative scoring scales of collateral assessment are commonly used, they are limited due to complex method which may be time- and skill-intensive and their broader use is limited due to the lack of a standardised method [ 1 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Sinha

Stanwell

Beran

et al. 2021

Neurology International

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Background: The interplay between collateral status and stroke aetiology may be crucial in the evaluation and management of acute ischemic stroke (AIS). Our understanding of this relationship and its level of association remains sub-optimal. This study sought to examine the association of pre-intervention collateral status with stroke aetiology, specifically large artery atherosclerosis (LAA) and cardio-embolism (CE), in AIS patients receiving reperfusion therapy, by performing a meta-analysis. Methods: Relevant search terms were explored on Medline/PubMed, Embase and Cochrane databases. Studies were included using the following inclusion criteria: (a) patients aged 18 or above; (b) AIS patients; (c) patients receiving reperfusion therapy; (d) total cohort size of >20, and (e) qualitative or quantitative assessment of pre-intervention collateral status on imaging using a grading scale. Random-effects meta-analysis was performed to investigate the association of aetiology with pre-intervention collateral status, and forest plots of risk ratio (RR) were generated. Results: A meta-analysis was conducted on seven studies, with a cumulative cohort of 1235 patients, to assess the association of pre-intervention collateral status with stroke aetiology. Patients with LAA were associated significantly with an increased rate of good collaterals (RR 1.24; 95% CI 1.04–1.50; p = 0.020, z = 2.33). Contrarily, CE aetiology was associated significantly with a decreased rate of good collaterals (RR 0.83; 95% CI 0.71–0.98; p = 0.027, z = −2.213). Conclusions: This study demonstrates that, in AIS patients receiving reperfusion therapy, LAA and CE aetiologies are associated significantly with collateral status.

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Section: Discussionmentioning

confidence: 99%

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Sinha

Stanwell

Beran

et al. 2021

Neurology International

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“…The most widely recognised grading system based on DSA is the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral scale [11]. Using the ASITN/SIR collateral scale, good collaterals were associated with favourable outcome in the Endovascular Stroke Treatment registry and in the Endovascular Treatment in Ischemic Stroke registry [12,13].…”

Section: Introductionmentioning

confidence: 99%

Association of the Careggi Collateral Score with 3-month modified Rankin Scale score after thrombectomy for stroke with occlusion of the middle cerebral artery

et al. 2021

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Background The Careggi Collateral Score (CCS) (qualitative-quantitative evaluation) was developed from a single-centre cohort as an angiographic score to describe both the extension and effectiveness of the pial collateral circulation in stroke patients with occlusion of the anterior circulation. We aimed to examine the association between CCS (quantitative evaluation) and 3-month modified Rankin Scale (mRS) score in a large multi-center cohort of patients receiving thrombectomy for stroke with occlusion of middle cerebral artery (MCA). Methods We conducted a study on prospectively collected data from 1284 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. According to the extension of the retrograde reperfusion in the cortical anterior cerebral artery (ACA)-MCA territories, CCS ranges from 0 (absence of retrograde filling) to 4 (visualization of collaterals until the alar segment of the MCA). Results Using CCS of 4 as reference, CCS grades were associated in the direction of unfavourable outcome on 3-month mRS shift (0 to 6); significant difference was found between CCS of 0 and CCS of 1 and between CCS of 3 and CCS of 4. CCS ≥ 3 was the optimal cut-off for predicting 3-month excellent outcome, while CCS ≥ 1 was the optimal cut-off for predicting 3-month survival. CCS of 0 and CCS < 3 were associated in the direction of unfavourable recanalization on TICI shift (0 to 3) compared with CCS ≥ 1 and CCS ≥ 3, respectively. Compared with CCS ≥ 3 as reference, CCS of 0 and CCS 1 to 2 were associated in the direction of unfavourable recanalization on TICI shift. There was no evidence of heterogeneity of effects of successful recanalization and procedure time ≤ 60 min on 3-month mRS shift across CCS categories. ConclusionThe CCS could provide a future advantage for improving the prognosis in patients receiving thrombectomy for stroke with M1 or M1-M2 segment of the MCA occlusion.

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“…Collateral circulation is essential to maintain blood flow to the ischemic brain tissue in the setting of large vessel occlusions. Retrograde collaterals may additionally enhance IVT delivery to the thrombus and increase shear stress, which in turn may facilitate thrombus fragmentation by IVT 8–12. Previous studies have shown a link between robust collateral circulation and higher recanalization, thrombus shortening, and favorable functional outcome after IVT 8–11.…”

Section: Discussionmentioning

confidence: 99%

“…There is therefore an urgent need to identify factors that may help to select patients who are most likely to benefit from IVT prior to EVT with the aim to individualize therapy. Collateral circulation, which plays a major role in maintaining blood flow to the penumbral tissue, has been identified as an important predictor of successful reperfusion and favorable functional outcome after IVT and EVT 8–12. It is still unknown, however, if collateral status modifies the effect of IVT on the outcomes of EVT.…”

Section: Introductionmentioning

confidence: 99%

Effect of intravenous thrombolysis before endovascular therapy on outcome according to collateral status: insight from the ETIS Registry

Anadani

Januel

Finitsis

et al. 2022

J NeuroIntervent Surg

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BackgroundIt is unknown whether collateral status modifies the effect of pretreatment intravenous thrombolysis (IVT) on the outcomes of patients with large vessel occlusions treated with endovascular therapy (EVT). We aimed to assess whether collateral status modifies the effect of IVT on the outcomes of EVT in clinical practice.MethodsWe used data from the ongoing prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France. Patients with anterior circulation proximal large vessel occlusions treated with EVT within 6 hours of symptom onset were enrolled. Patients were divided into two groups based on pretreatment with IVT. The two groups were matched based on baseline characteristics. We tested the interaction between collateral status and IVT in unadjusted and adjusted models.ResultsA total of 1589 patients were enrolled in the study, of whom 55% received IVT. Using a propensity score matching method, 724 no IVT patients were matched to 549 IVT patients. In propensity score weighted analysis, IVT was associated with higher odds of early neurological improvement (OR 1.74; 95% CI 1.33 to 2.26), favorable functional outcome (OR 1.66; 95% CI 1.23 to 2.24), excellent functional outcome (OR 2.04; 95% CI 1.47 to 2.83), and successful reperfusion (OR 2.18; 95% CI 1.51 to 3.16). IVT was not associated with mortality or hemorrhagic complications. There was no interaction between collateral status and IVT association with any of the outcomes.ConclusionsCollateral status does not modify the effect of pretreatment IVT on the efficacy and safety outcomes of EVT.

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Collateral status reperfusion and outcomes after endovascular therapy: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) Registry

Cited by 26 publications

References 25 publications

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Association of the Careggi Collateral Score with 3-month modified Rankin Scale score after thrombectomy for stroke with occlusion of the middle cerebral artery

Effect of intravenous thrombolysis before endovascular therapy on outcome according to collateral status: insight from the ETIS Registry

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