TY - JOUR
T1 - Clinical Outcome Predicted by Collaterals Depends on Technical Success of Mechanical Thrombectomy in Middle Cerebral Artery Occlusion
AU - Gersing, Alexandra S.
AU - Schwaiger, Benedikt J.
AU - Kleine, Justus F.
AU - Kaesmacher, Johannes
AU - Wunderlich, Silke
AU - Friedrich, Benjamin
AU - Prothmann, Sascha
AU - Zimmer, Claus
AU - Boeckh-Behrens, Tobias
N1 - Publisher Copyright:
© 2017 National Stroke Association
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Background This study aimed to analyze the effects of technical outcome of mechanical thrombectomy (MTE) on the associations between collateral status, assessed with pretreatment computed tomography angiography (CTA), and neurological and functional outcome, as well as associations between collaterals and metabolic risk factors (arterial hypertension, diabetes, hyperlipidemia, overweight). Methods Prospectively collected data of 115 patients with CTA-proven isolated middle cerebral artery occlusion treated successfully with MTE (Thrombosis in Cerebral Infarction [TICI] scale 2b or 3) were assessed retrospectively. Initial CTAs were assessed for the regional leptomeningeal collateralization score (rLMC), neurological status was determined with the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge, and mid-term functional outcome was assessed using the modified Rankin scale (mRS) 90 days after MTE. Results NIHSS score at admission was significantly associated with rLMC (P = .004), whereas rLMC and NIHSS at discharge showed no significant associations (P = .12). Better rLMC was significantly associated with improved mid-term mRS (P = .018). This association was even more significant after complete MTE (TICI 3; P = .011). Arterial hypertension was significantly more often found in patients with poor rLMC (0-10) than in patients with good rLMC (11-20; P = .046), yet other risk factors showed no significant associations (P > .05). Conclusions In patients with successful MTE, good collaterals were associated with better neurological status at admission and favorable mid-term functional outcome. In patients with complete MTE, associations were even more significant compared with those with “almost complete” MTE, suggesting a synergistic effect between good collaterals and complete MTE and a predictive value of collaterals for estimation of the potential clinical benefit of MTE.
AB - Background This study aimed to analyze the effects of technical outcome of mechanical thrombectomy (MTE) on the associations between collateral status, assessed with pretreatment computed tomography angiography (CTA), and neurological and functional outcome, as well as associations between collaterals and metabolic risk factors (arterial hypertension, diabetes, hyperlipidemia, overweight). Methods Prospectively collected data of 115 patients with CTA-proven isolated middle cerebral artery occlusion treated successfully with MTE (Thrombosis in Cerebral Infarction [TICI] scale 2b or 3) were assessed retrospectively. Initial CTAs were assessed for the regional leptomeningeal collateralization score (rLMC), neurological status was determined with the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge, and mid-term functional outcome was assessed using the modified Rankin scale (mRS) 90 days after MTE. Results NIHSS score at admission was significantly associated with rLMC (P = .004), whereas rLMC and NIHSS at discharge showed no significant associations (P = .12). Better rLMC was significantly associated with improved mid-term mRS (P = .018). This association was even more significant after complete MTE (TICI 3; P = .011). Arterial hypertension was significantly more often found in patients with poor rLMC (0-10) than in patients with good rLMC (11-20; P = .046), yet other risk factors showed no significant associations (P > .05). Conclusions In patients with successful MTE, good collaterals were associated with better neurological status at admission and favorable mid-term functional outcome. In patients with complete MTE, associations were even more significant compared with those with “almost complete” MTE, suggesting a synergistic effect between good collaterals and complete MTE and a predictive value of collaterals for estimation of the potential clinical benefit of MTE.
KW - collateralization
KW - endovascular therapy
KW - mechanical thrombectomy
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85006753346&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2016.10.020
DO - 10.1016/j.jstrokecerebrovasdis.2016.10.020
M3 - Article
C2 - 27856113
AN - SCOPUS:85006753346
SN - 1052-3057
VL - 26
SP - 801
EP - 808
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 4
ER -
