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Leptomeningeal Collateral Flow Modifies Endovascular Treatment Efficacy on Large-Vessel Occlusion Strokes
Álvaro García-Tornel1, Ludovico Ciolli2, Marta Rubiera1
1Stroke Unit, Department of Neurology (A.G.-T., M. Rubiera, M. Requena, M.M., J.P., D.R.-L, M.D., J.J., N.R.-V., S.B., M.O.-G., E.S., J.A.-S., C.A.M., M. Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
Good collateral flow (CF) in large-vessel stroke patients undergoing endovascular therapy (EVT) is linked to better reperfusion outcomes and fewer device passes. This suggests CF improves EVT efficacy by aiding clot retrieval and preventing embolization.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Medicine
Background:
- Large-vessel occlusion stroke requires timely reperfusion.
- Endovascular therapy (EVT) is a primary treatment for large-vessel occlusion stroke.
- Collateral flow (CF) may influence EVT outcomes, but its precise role needs clarification.
Purpose of the Study:
- To evaluate if good collateral flow (CF) modifies endovascular therapy (EVT) efficacy in large-vessel stroke.
- To determine the association between CF and reperfusion success (mTICI score).
- To assess the relationship between CF and the number of device passes required for reperfusion.
Main Methods:
- Retrospective single-center study of 626 patients with anterior circulation large-vessel stroke treated with EVT.
- Collateral flow (CF) assessed on pre-EVT CT angiography using a 4-grade score.
- Final reperfusion (mTICI) and device passes prospectively collected; multivariable analysis performed.
Main Results:
- Good CF was present in 59% of patients (369/626).
- Good CF was independently associated with better final reperfusion rates (mTICI 2B-3 and 2C-3).
- Poor CF was independently associated with a higher number of device passes for successful and complete reperfusion.
Conclusions:
- Good collateral flow (CF) in patients with large-vessel stroke undergoing EVT is associated with higher rates of successful reperfusion.
- Good CF correlates with a lower number of device passes needed for effective reperfusion.
- CF may enhance EVT efficacy by facilitating thrombus retrieval and preventing distal embolization.
Background And Purpose:
We aim to evaluate if good collateral flow (CF) modifies endovascular therapy (EVT) efficacy on large-vessel stroke. To do that, we used final degree of reperfusion and number of device-passes performed, factors previously associated with better functional outcome, as main outcome measures.
Methods:
Single-center retrospective study including consecutive stroke patients receiving EVT for anterior circulation large-vessel stroke. CF degree was assessed on CT angiography before EVT using a previously validated 4-grade score. Final degree of reperfusion, using modified Thrombolysis in Cerebral Ischemia (mTICI), and number of device-passes performed were prospectively collected. Multivariable analysis was performed to evaluate the influence of collateral flow degree on final degree of reperfusion and number of device-passes performed.
Results:
Six hundred twenty-six patients were included in the study; 369 patients (59%) presented good collateral flow on CT angiography. Five hundred twenty-two patients (84%) achieved successful reperfusion (mTICI 2B-3) after EVT, 304 (48%) of them with a final mTICI 2C-3. Median number of device-passes was 2 (interquartile range, 1-3). Good CF was independently associated with better final degree of reperfusion (shift analysis for mTICI0-2A/2B/2C-3%, poor CF 19/38/43 versus good CF 15/32/53, adjusted odds ratio, 1.51 [95% CI, 1.08-2.11]). Poor CF was independently associated with higher number of device-passes performed to achieve successful reperfusion (mTICI2B-3; shift analysis for 1/2/3/4+ device-passes, adjusted odds ratio, 1.59, [95% CI, 1.09-2.31]) and complete reperfusion (mTICI2C-3; shift analysis for 1/2/3/4+ device-passes, adjusted odds ratio, 1.70 [95% CI, 1.04-2.90]).
Conclusions:
Patients with good CF treated with EVT experience higher rates of successful reperfusion with lower number of device-passes. CF may facilitate thrombus retrieval and prevent distal embolization of clot fragments, improving device-passes efficacy.
