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Published on: June 4, 2021
Impact of collaterals on successful revascularization in Solitaire FR with the intention for thrombectomy
David S Liebeskind1, Reza Jahan2, Raul G Nogueira2
1From the UCLA Stroke Center (D.S.L., R.J., J.L.S.); Emory University School of Medicine, Atlanta, GA (R.G.N.); and Medical College of Wisconsin, Froedtert Hospital, Milwaukee (O.O.Z.). davidliebeskind@yahoo.com.
Insights
Better collateral circulation in stroke patients undergoing endovascular therapy is linked to successful revascularization without hemorrhage and improved clinical outcomes. This finding emphasizes the importance of assessing collaterals in stroke treatment planning.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Imaging
Background:
- The Solitaire FR With the Intention for Thrombectomy (SWIFT) study investigated endovascular therapy for acute ischemic stroke.
- Collateral circulation, a critical factor in stroke, influences reperfusion and clinical outcomes.
- Assessing collateral status pre-treatment is vital for predicting treatment success.
Purpose of the Study:
- To analyze the effect of pre-endovascular therapy collateral status on successful revascularization without symptomatic hemorrhage.
- To evaluate the relationship between collateral grade and clinical, laboratory, and imaging parameters in stroke patients.
Main Methods:
- Collateral grade was assessed from baseline angiography using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale.
- Independent assessment was performed blind to other patient data.
- Statistical analyses explored correlations with clinical, laboratory, and imaging variables.
Main Results:
- Worse collaterals were associated with higher baseline blood glucose and systolic blood pressure.
- Predictors of worse collaterals included absence of hypertension, smoking history, and elevated blood glucose.
- Better collaterals correlated with higher Alberta Stroke Program Early CT Score (ASPECTS), successful reperfusion (Thrombolysis in Cerebral Infarction 2b/3), and improved functional outcomes (NIHSS, mRS).
Conclusions:
- Enhanced collateral circulation is associated with better baseline infarct size, lower glucose and blood pressure, and successful revascularization without hemorrhage.
- Improved collateral status predicts favorable clinical outcomes in stroke patients treated with endovascular therapy.
Background And Purpose:
Collaterals at angiography before endovascular therapy were analyzed to ascertain the effect on a novel end point of successful revascularization without symptomatic hemorrhage in the Solitaire FR With the Intention for Thrombectomy (SWIFT) study.
Methods:
Collateral grade (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology) on baseline angiography was independently assessed, blind to other data, with statistical analyses delineating the relationship with clinical, laboratory, and imaging parameters.
Results:
Angiographic data on collaterals were available in 119 of 144 subjects (mean age, 67±12 years; 52% woman; median National Institutes of Health Stroke Scale, 18 [range, 8-28]). Worse collaterals were noted in subjects with elevated baseline blood glucose (P=0.013) and those with elevated baseline systolic blood pressure (P=0.039). Multivariate predictors of partial or worse collaterals included absence of prior hypertension (odds ratio, 4.049, P=0.012), smoking history (odds ratio, 3.822; P=0.013), and higher blood glucose (odds ratio, 1.017; P=0.022). Collaterals were strongly related to Alberta Stroke Program Early CT Score (ASPECTS) at baseline (0-1: median 8 [3-10]; 2-9 [5-10]; 3-9 [7-10]; 4-9 [8-10]; P<0.001) and 24 hours (0-1: median 1 [0-5]; 2-6 [0-10]; 3-8 [0-10]; 4-8 [4-8]; P<0.001). Better collaterals were linked with Thrombolysis in Cerebral Infarction 2b/3 reperfusion (P=0.019), better median National Institutes of Health Stroke Scale at day 7/discharge (P<0.001), and better day 90 modified Rankin Scale (P<0.001). Better collateral grade was associated with successful revascularization without symptomatic hemorrhage, mean 2.3 (95% confidence interval, 2.1-2.5) versus 1.9 (95% confidence interval, 1.7-2.2), P=0.021.
Conclusions:
Better collaterals were associated with lower glucose, lower blood pressure, smaller baseline infarcts in SWIFT, and greater likelihood of successful revascularization without hemorrhage and good clinical outcomes.
Clinical Trial Registration Url:
http://www.clinicaltrials.gov. Unique identifier: NCT01054560.
