Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients
Juha-Pekka Pienimäki1, Niko Sillanpää1, Pasi Jolma2
1Vascular and Interventional Radiology Center, Tampere University Hospital, Tampere, Finland.
Insights
Severe carotid stenosis (≥75%) in acute stroke patients was linked to significantly better intracranial collateral circulation. This improved collateral flow did not alter 3-month clinical outcomes following mechanical thrombectomy.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Adequate collateral circulation is crucial for improving clinical outcomes in patients with ischemic stroke.
- The influence of ipsilateral carotid stenosis on intracranial collateral circulation in acute stroke patients requires further investigation.
Purpose of the Study:
- To evaluate the impact of ipsilateral carotid stenosis on intracranial collateral circulation in acute ischemic stroke patients undergoing mechanical thrombectomy.
Main Methods:
- A retrospective analysis of 385 acute stroke patients with middle cerebral artery (M1) occlusion who underwent mechanical thrombectomy.
- Multimodal computed tomography (CT) imaging was used to assess intracranial collateral circulation.
- Statistical tests and ordinal regression analysis were employed to study the effect of carotid stenosis on collateral circulation.
Main Results:
- Fifty of 247 eligible patients (20.2%) had severe ipsilateral carotid stenosis (≥75%).
- Patients with severe stenosis were four times more likely to have very good intracranial collaterals (Collateral Score 3-4) compared to those with less stenosis (p = 0.001).
- Severely stenotic patients experienced longer reperfusion times (mean 41 min vs. 29 min, p = 0.001), but 54% achieved good 3-month clinical outcomes (modified Rankin Scale ≤2) with no significant difference between groups.
Conclusions:
- Severe carotid artery stenosis (≥75%) is associated with enhanced intracranial collateral circulation in acute ischemic stroke patients.
- Despite improved collateral flow, severe carotid stenosis did not significantly impact 3-month clinical outcomes after mechanical thrombectomy.
Background:
Adequate collateral circulation improves the clinical outcome of ischemic stroke patients. We evaluated the influence of ipsilateral carotid stenosis on intracranial collateral circulation in acute stroke patients.
Methods:
We collected the data of 385 consecutive acute stroke patients who underwent mechanical thrombectomy after multimodal computed tomography (CT) imaging in a single high-volume stroke center. Patients with occlusion of the first segment (M1) segment of the middle cerebral artery were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of carotid stenosis on intracranial collateral circulation was studied with appropriate statistical tests and ordinal regression analysis.
Results:
Fifty out of the 247 patients eligible for analysis had severe ipsilateral carotid stenosis (≥75%). These patients were 4-times more likely to have very good intracranial collaterals (Collateral Score 3-4, p = 0.001) than the nonstenotic and slightly stenotic (<75%) patients. The severely stenotic patients had a longer mean operation time (41 vs. 29 min to reperfusion, respectively, p = 0.001). Nevertheless, 54% of severely stenotic patients had good 3-month clinical outcome (modified Rankin Scale ≤2) with no significant difference between the 2 groups.
Conclusions:
Carotid artery stenosis of over 75% of vessel diameter was associated with better intracranial collateral circulation of patients with acute ischemic stroke. This did not significantly change the 3-month clinical outcome.
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