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Physiologic predictors of collateral circulation and infarct growth during anesthesia - Detailed analyses of the

Radoslav Raychev1, David S Liebeskind1, Albert J Yoo2

  • 1Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.

Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism
|August 2, 2019
PubMed

Insights

Hypotension during endovascular therapy (EVT) for large vessel occlusion (LVO) stroke worsens collateral circulation. Higher phenylephrine doses predict infarct growth, emphasizing the need to avoid anesthesia-induced hypotension to preserve collaterals and minimize stroke progression.

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Medical Imaging

Background:

  • Collateral circulation is crucial in acute ischemic stroke with large vessel occlusion (LVO).
  • Sedation variables during endovascular therapy (EVT) can impact collateral function.
  • Predicting collateral grade and infarct growth is vital for optimizing patient outcomes.

Purpose of the Study:

  • To identify predictors of collateral circulation grade and infarct growth in LVO stroke patients undergoing EVT.
  • To evaluate the modified ASITN collateral grading scale's impact on clinical outcome and infarct growth.

Main Methods:

  • Detailed analysis of the GOLIATH trial data.
  • Multivariable and ordinal regression analyses were used to identify predictors.
  • Assessment of baseline clinical and procedural variables, including phenylephrine dose and mean arterial pressure (MAP).

Main Results:

  • Phenylephrine dose (estimate 6.78, p=0.014) and baseline infarct volume (estimate 0.93, p=0.03) significantly predicted infarct growth at 24h.
  • MAP <70 mmHg (OR 0.35, p=0.048) and baseline infarct volume (OR 0.96, p=0.003) were significant predictors of worse collateral grade.
  • A modified ASITN scale showed a non-significant association with infarct growth.

Conclusions:

  • Anesthesia-induced hypotension during EVT for LVO negatively impacts collateral circulation.
  • Higher pressor doses (e.g., phenylephrine) are associated with increased infarct growth.
  • Avoiding hypotension and minimizing pressor use may preserve collateral function and reduce infarct size in LVO stroke.

Keywords:
Anesthesiacollateralshypotensionstrokethrombectomy

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