Does Small Vessel Disease Burden Impact Collateral Circulation in Ischemic Stroke Treated by Mechanical Thrombectomy?

Area of Science:

• Neurology
• Vascular Medicine
• Radiology

Background:

• Leptomeningeal collateral artery network development is vital for stroke recovery.
• Small vessel wall alterations may negatively impact collateral formation.
• Understanding factors influencing collateralization is key in acute ischemic stroke management.

Purpose of the Study:

• To investigate the association between small vessel disease (SVD) burden and collateral development.
• To assess if SVD impacts collateralization in patients undergoing mechanical thrombectomy for anterior circulation acute ischemic stroke.

Main Methods:

• Retrospective analysis of 240 patients with acute ischemic stroke treated with mechanical thrombectomy.
• Assessment of SVD burden using the cerebral SVD score on MRI.
• Evaluation of pial collaterality using the Higashida score on digital subtraction angiography.

Main Results:

• No significant association was found between the cerebral SVD score and the collaterality pattern (OR, 1.11; 95% CI, 0.82-1.50; P=0.51).
• 136 patients (58.1%) had favorable collaterality.
• Favorable collaterality was associated with female sex, lower NIHSS, and higher DWI-ASPECTS.

Conclusions:

• The burden of small vessel disease does not appear to influence collateral flow status in patients with anterior circulation acute ischemic stroke.
• These findings suggest SVD may not be a primary determinant of collateralization in this patient cohort.