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Effect of thrombectomy on oedema progression and clinical outcome in patients with a poor collateral profile

Gabriel Broocks1, Andre Kemmling2,3, Tobias Faizy4

  • 1Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany G.broocks@uke.de.

Stroke and Vascular Neurology
|November 19, 2020
PubMed

Insights

Successful reperfusion therapy significantly reduces brain swelling and improves outcomes in ischemic stroke patients with poor collateral circulation. These findings suggest that patients with poor collaterals should not be excluded from thrombectomy.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Stroke Medicine

Background:

  • Cerebral collateral circulation significantly impacts ischemic stroke progression and patient outcomes.
  • Collateral status has historically influenced patient selection for endovascular treatment.
  • Poor collateral profiles are generally associated with worse clinical outcomes in stroke.

Purpose of the Study:

  • To evaluate the effect of vessel recanalization on lesion pathophysiology in ischemic stroke patients with poor collateral status.
  • To determine the impact of successful reperfusion on clinical outcomes in this specific patient cohort.

Main Methods:

  • 129 patients with anterior circulation large vessel occlusion and a low collateral score (0-2) were analyzed.
  • Collateral status was assessed using CT angiography (CTA) with a 5-point scoring system.
  • Lesion progression was quantified by water uptake on CT, and clinical outcomes were measured by modified Rankin Scale (mRS) at 90 days.

Main Results:

  • Vessel recanalization was associated with significantly reduced edema formation (19.5% vs. 27%, p<0.0001).
  • Successful recanalization independently predicted lower edema on follow-up CT (ß=-7.31, p<0.0001).
  • Patients achieving recanalization had significantly better functional outcomes at 90 days (mRS 4.5 vs. 5, p<0.001).

Conclusions:

  • Endovascular recanalization improves outcomes even in ischemic stroke patients with poor collateral circulation.
  • Significant edema reduction and better functional outcomes were observed post-recanalization in this group.
  • These findings support the inclusion of patients with poor collaterals in thrombectomy consideration.
Abstract

Keywords:
CTinterventionlesionstrokethrombectomy

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