Greater infarct growth limiting effect of mechanical thrombectomy in stroke patients with poor collaterals

Journal of Neurointerventional Surgery
Arturo RenúXabier Urra

Abstract

Stroke patients with good collateral circulation achieve the best recovery after mechanical thrombectomy (MT) but strict imaging selection may result in untreated patients that could benefit from MT. We assessed whether the extent of collaterals had modifying effects on the amount of ischemic tissue saved from infarction with MT over best medical treatment (BMT). This was a single center cohort of consecutive patients (n=339) with proximal occlusions in the carotid territory. Patients were categorized according to a four point category scale on CT angiography as having good (scores 2-3) or poor (scores 0-1) collaterals. The primary outcome measure was the interaction between collaterals and MT on infarct growth. The secondary outcome assessed the treatment effect of MT over BMT on functional status in relation to collateral status. Safety outcomes were mortality and symptomatic intracranial hemorrhage. Collaterals had a modifying effect of MT on infarct growth (P=0.004), with a greater reduction in 96 patients with poor collaterals (38.8 mL) than in 243 patients with good collaterals (1.9 mL). There was also a significant (P<0.001) interaction between the effect of MT and functional outcome in relation to collateral status, wit...Continue Reading

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Citations

Jul 6, 2019·Journal of Neurointerventional Surgery·Arturo Renú JornetAngel Chamorro
Apr 29, 2020·Acta Neurologica Scandinavica·Jiacheng QianYujie Wang
May 20, 2020·Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism·Anna Luisa KühnMatthew J Gounis
Feb 1, 2020·AJNR. American Journal of Neuroradiology·H RaoultB Laviolle
Oct 23, 2020·Cerebrovascular Diseases Extra·Juha-Pekka PienimäkiNiko Sillanpää

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