Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial

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Updated: May 3, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

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David S Liebeskind1, Thomas A Tomsick, Lydia D Foster

  • 1From UCLA Stroke Center, Los Angeles, CA (D.S.L.); University of Cincinnati, Cincinnati, OH (T.A.T., J.C., P.K., J.P.B.); Medical University of South Carolina, Charleston, SC (L.D.F., S.D.Y., Y.Y.P.); Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.G., B.K.M.); UPMC Stroke Institute, Pittsburgh, PA (T.G.J.); Department of Neuroradiology, University of Dresden, Dresden, Germany (R.v.K.); University of Mississippi, Jackson, MS (R.M.S.); Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI (O.O.Z.); Michigan State University, East Lansing, MI (S.I.H.); Summit Neurovascular Specialties and Akron General Hospital, Akron, OH (F.A.A.); and Royal Melbourne Hospital, Parkville, Victoria, Australia (B.Y.).

Stroke
|January 30, 2014
PubMed

Insights

Better collateral circulation in stroke patients undergoing endovascular therapy correlates with improved recanalization, reperfusion, and clinical outcomes. These findings highlight the importance of assessing collateral grade in stroke treatment and future trial design.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Vascular Medicine

Background:

  • Endovascular therapy offers a unique window to assess collateral circulation during stroke treatment.
  • The Interventional Management of Stroke (IMS) III trial provides a large dataset for analyzing these correlations.

Purpose of the Study:

  • To systematically analyze the relationship between angiographic collateral circulation and outcomes in the endovascular treatment arm of the IMS III trial.
  • To investigate the impact of collateral grade on recanalization, reperfusion, and clinical outcomes.

Main Methods:

  • Prospective evaluation of collateral grade using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale in 331 endovascularly treated stroke patients.
  • Central review of angiographic data, blinded to other clinical information.
  • Statistical analyses to determine associations between collateral grade, recanalization, reperfusion, and 90-day clinical outcomes (modified Rankin Scale).

Main Results:

  • Adequate collateral views were obtained in 83% of subjects.
  • Higher collateral grade strongly correlated with successful recanalization (P=0.0016) and improved downstream reperfusion (P<0.0001).
  • Multivariable analysis confirmed robust collateral grade as a significant predictor of good clinical outcome (mRS ≤2) at 90 days (P=0.0353), independent of other factors.

Conclusions:

  • Increased collateral grade is associated with enhanced recanalization, reperfusion, and better clinical outcomes in stroke patients treated with endovascular therapy.
  • These findings from the IMS III trial emphasize the critical role of collateral circulation in stroke management and future clinical trial design.
Abstract

Keywords:
angiographycollateral circulationreperfusionstroke

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