Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: a systematic review and meta-analysis

Leng, Xinyi; Fang, Hui; Leung, Thomas W.; Chen, Mao; Miao, Zhongrong; Liu, Liping; Wong, Ka Sing; Liebeskind, David S

doi:10.1136/jnnp-2015-310965

Cited by 114 publications

(104 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Tissue fate in such patients is likely to be highly dependent on time and extent of reperfusion. Because good collateral flow is independently associated with higher rates of reperfusion, smaller final infarct sizes, lower rates of SICH, and better clinical outcomes after endovascular therapy, 16,17 we think that the previously described associations between large T max >10 s lesion volumes and worse outcomes do exist but are likely dependent both on the time from imaging to reperfusion and on the final degree of reperfusion.…”

Section: Discussionmentioning

confidence: 95%

Large Volumes of Critically Hypoperfused Penumbral Tissue Do Not Preclude Good Outcomes After Complete Endovascular Reperfusion

Nogueira

Haussen

Dehkharghani

et al. 2016

Stroke

View full text Add to dashboard Cite

R eperfusion therapy remains the mainstay of acute ischemic stroke treatment but its clinical benefit comes at the cost of potential harm from reperfusion injury leading to cerebral edema and hemorrhagic complications. Advanced computed tomography (CT) and magnetic resonance imaging (MRI) techniques have emerged as promising tools to improve treatment selection by excluding patients who are particularly prone to harm and have low chances of benefit. The term Malignant profile was originally proposed by the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study (DEFUSE) investigators to describe imaging patterns of severe cerebral ischemia associated with high likelihood of symptomatic intracranial hemorrhage (SICH) or poor outcome after reperfusion in acute ischemic stroke and was empirically defined as a baseline lesion on diffusion-weighted MRI (DWI) >100 mL or a lesion on Background and Purpose-Acute ischemic stroke patients with large volumes of severe hypoperfusion (T max >10 s>100 mL) on magnetic resonance imaging have a higher likelihood of intracranial hemorrhage and poor outcomes after reperfusion. We aim to evaluate the impact of the extent of T max >10 s CTP lesions in patients undergoing successful treatment. Methods-Retrospective database review of endovascular acute ischemic stroke treatment between September 2010 and March 2015 for patients with anterior circulation occlusions with baseline RAPID CTP and full reperfusion (mTICI 3). The primary outcome was the impact of the T max >10 s lesion spectrum on infarct growth. Secondary safety and efficacy outcomes included parenchymal hematomas and good clinical outcomes (90-day modified Rankin Scale score, 0-2). Results-Of 684 treated patients, 113 patients fit the inclusion criteria. T max >10 s>100 mL patients (n=37) had significantly higher baseline National Institutes of Health Stroke Scale (20.7±3.8 versus 17.0±5.9; P<0.01), more internal carotid artery terminus occlusions (29% versus 9%; P=0.02), and larger baseline (38.6±29.6 versus 11.7±15.8 mL; P<0.01) and final (60.7±60.0 versus 29.4±33.9 mL; P<0.01) infarct volumes when compared with patients without T max >10 s >100 mL (n=76); however, the 2 groups were otherwise well balanced. There were no significant differences in infarct growth (22.1±51.6 versus 17.8±32.4 mL; P=0.78), severe intracranial hemorrhage (PH2: 2% versus 4%; P=0.73), good outcomes (90-day mRS score, 0-2: 56% versus 59%; P=0.83), or 90-day mortality (16% versus 7%; P=0.28). On multivariate analysis, only baseline National Institutes of Health Stroke Scale (odds ratio, 1.19; 95% confidence interval, 1.06-1.34; P<0.01) and baseline infarct core volume (odds ratio, 1.05; 95% confidence interval, 1.02-1.08; P<0.01) were independently associated with T max >10 s>100 mL. There was no association between T max >10 s>100 mL with any PH, good outcome, or infarct growth. Conclusions-In the setting of limited baseline ischemic cores, large T max >10 s lesions on computed tomographic perfusion do not seem to be...

show abstract

Section: Discussionmentioning

confidence: 95%

Large Volumes of Critically Hypoperfused Penumbral Tissue Do Not Preclude Good Outcomes After Complete Endovascular Reperfusion

Nogueira

Haussen

Dehkharghani

et al. 2016

Stroke

View full text Add to dashboard Cite

show abstract

“…Improved collateral circulation also predicts higher rates of recanalization, favorable outcomes and lower rates of mortality 9,10,50 . The absence or relative paucity of a collateral network is a major predictor of extensive infarct on admission 56 , and a proximal thrombus associated with such an absence has been termed a "malignant profile"…”

Section: Teaching Points For Clinical Usementioning

confidence: 99%

“…Assessments of collaterals in angiographic studies have proven be widely variable. A recent meta-analysis by Leng et al 9 found 12 studies that used the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral flow grading system by DSA and primarily defined grades 3-4 and 0-2 as good and poor collateral statuses, respectively. Eleven studies have used other grading methods for DSA, 9 studies have used different grading methods for CTA, and others have used CTP or combined grading methods with different imaging modalities.…”

Section: Imaging Studies Of Collateral Circulation In the Clinical Sementioning

confidence: 99%

“…The ASITN/SIR classification involves a five-point system ( Table 1) that has been used in several endovascular trials 9,10,49,50,51,52 . Grades 0 and 1 indicate only marginal flow, grade 2 indicates only partial filling of the ischemic territory, and grades 3 and 4 indicate varying rates of complete filling of the occluded arterial territory.…”

Section: Imaging Studies Of Collateral Circulation In the Clinical Sementioning

confidence: 99%

“…However, although EVT has been shown to be generally effective, the trials have documented erratic individual and overall patient outcomes. These differences may not be solely the result of the various methods used but may also be related to patient-specific characteristics 9 . Among these patientspecific characteristics, collateral status has emerged as an independent factor that is associated with angiographic and clinical outcomes in AIS patients 10,11 .…”

mentioning

confidence: 99%

See 2 more Smart Citations

Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

Alves¹,

Pacheco²,

Rocha³

2016

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Collateral circulation is a physiologic pathway that protects the brain against ischemic injury and can potentially bypass the effect of a blocked artery, thereby influencing ischemic lesion size and growth. Several recent stroke trials have provided information about the role of collaterals in stroke pathophysiology, and collateral perfusion has been recognized to influence arterial recanalization, reperfusion, hemorrhagic transformation, and neurological outcomes after stroke. Our current aim is to summarize the anatomy and physiology of the collateral circulation and to present and discuss a comprehensible review of the related knowledge, particularly the effects of collateral circulation on the time course of ischemic injury and stroke severity, as well as imaging findings and therapeutic implications.

show abstract

Quantitative time‐of‐flight MR angiography for simultaneous luminal and hemodynamic evaluation of the intracranial arteries

Koktzoglou

Edelman

2021

Magnetic Resonance in Med

View full text Add to dashboard Cite

Purpose: To report a quantitative time-of-flight (qTOF) MRA technique for simultaneous luminal and hemodynamic evaluation of the intracranial arteries. Methods: Implemented using a thin overlapping slab 3D stack-of-stars based 3-echo FLASH readout, qTOF was tested in a flow phantom and for imaging the intracranial arteries of 10 human subjects at 3 Tesla. Display of the intracranial arteries with qTOF was compared to resolution-matched and scan time-matched standard Cartesian 3D time-of-flight (TOF) MRA, whereas quantification of mean blood flow velocity with qTOF, done using a computer vision-based inter-echo image analysis procedure, was compared to 3D phase contrast MRA. Arterial-to-background contrast-to-noise ratio was measured, and intraclass correlation coefficient was used to evaluate agreement of flow velocities. Results: For resolution-matched protocols of similar scan time, qTOF portrayed the intracranial arteries with good morphological correlation with standard Cartesian TOF, and both techniques provided superior contrast-to-noise ratio and arterial delineation compared to phase contrast (20.6 ± 3.0 and 37.8 ± 8.7 vs. 11.5 ± 2.2, P < .001, both comparisons). With respect to phase contrast, qTOF showed excellent agreement for measuring mean flow velocity in the flow phantom (intraclass correlation coefficient = 0.981, P < .001) and good agreement in the intracranial arteries (intraclass correlation coefficient = 0.700, P < .001). Stack-of-stars data sampling used with qTOF eliminated oblique in-plane flow misregistration artifacts that were seen with standard Cartesian TOF. Conclusion: qTOF is a new 3D MRA technique for simultaneous luminal and hemodynamic evaluation of the intracranial arteries that provides significantly greater contrast-to-noise ratio efficiency than phase contrast and eliminates misregistration artifacts from oblique in-plane blood flow that occur with standard 3D TOF.

show abstract

Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: a systematic review and meta-analysis

Abstract: Good pretreatment collateral status is associated with higher rates of favourable functional outcome, and lower rates of symptomatic intracranial haemorrhage and mortality, in patients with acute ischaemic stroke receiving endovascular therapies.

Cited by 114 publications

References 48 publications

Large Volumes of Critically Hypoperfused Penumbral Tissue Do Not Preclude Good Outcomes After Complete Endovascular Reperfusion

Large Volumes of Critically Hypoperfused Penumbral Tissue Do Not Preclude Good Outcomes After Complete Endovascular Reperfusion

Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

Quantitative time‐of‐flight MR angiography for simultaneous luminal and hemodynamic evaluation of the intracranial arteries

Contact Info

Product

Resources

About