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Published on: June 4, 2021
The Cerebral Collateral Cascade: Comprehensive Blood Flow in Ischemic Stroke.
Tobias Djamsched Faizy1, Michael Mlynash1, Reza Kabiri1
1From the Departments of Radiology (T.D.F., R.K., G.M.K., M.P.M., M.W., J.J.H.) and Neurology and Neurological Sciences (M.M., S.C., M.G.L., G.W.A.), Stanford University School of Medicine, CA; and Departments of Neuroradiology (T.D.F., R.K., F.F., G.B., J.F.) and Neurosurgery (M.M.M.), University Medical Center Hamburg-Eppendorf, Germany.
A comprehensive assessment of cerebral collateral blood flow cascade (CCC) in acute stroke patients undergoing thrombectomy predicts better functional independence and smaller infarct volumes. This holistic approach offers deeper insights than single biomarkers.
Area of Science:
- Neuroimaging
- Cerebrovascular Diseases
- Interventional Neurology
Background:
- Robust cerebral collaterals are crucial for favorable outcomes in acute ischemic stroke patients treated with thrombectomy.
- Current collateral assessment often relies on single imaging biomarkers, limiting a comprehensive understanding of collateral perfusion.
- A holistic approach evaluating the entire cerebral collateral cascade (CCC) may offer deeper biological insights.
Purpose of the Study:
- To hypothesize that a comprehensive analysis of the CCC, encompassing arterial, tissue, and venous levels, would predict clinical and radiologic outcomes.
- To evaluate the predictive value of a multi-level collateral assessment in patients with acute ischemic stroke undergoing thrombectomy.
Main Methods:
- Multicenter retrospective cohort study involving 647 patients with acute stroke undergoing thrombectomy triage.
- Cerebral collateral cascade (CCC) was quantified by assessing pial arterial collaterals (CT angiography), tissue-level collaterals (CT perfusion), and venous outflow (VO) using the cortical vein opacification score (CT angiography).
- Patients were categorized into CCC+ (good collaterals at all levels), CCC- (poor collaterals at all levels), and CCCmixed groups.
Main Results:
- The CCC+ group demonstrated significantly better functional outcomes (modified Rankin Scale 0-2 at 90 days) compared to CCC- and CCCmixed groups (OR 18.9, p < 0.001).
- CCCmixed patients showed better functional outcomes than CCC- patients (OR 2.5, p = 0.014).
- Both CCC+ and CCCmixed profiles were associated with substantially lower final infarct volumes compared to the CCC- profile (p < 0.001).
Conclusions:
- Comprehensive assessment of the cerebral collateral blood flow cascade is a strong predictor of clinical outcomes in acute stroke patients treated with thrombectomy.
- A multi-level evaluation of collaterals provides a more robust prognostic indicator than single-biomarker assessments.
- This holistic approach enhances understanding of collateral perfusion biology on medical imaging.
