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Collateral Status and Outcomes after Thrombectomy.

Jin Soo Lee1, Oh Young Bang2

  • 1Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea.

Translational Stroke Research
|June 10, 2022
PubMed
Summary
This summary is machine-generated.

Good collateral circulation in acute ischemic stroke patients undergoing endovascular treatment (EVT) predicts better outcomes. However, collateral status is underutilized in clinical decisions and trials for large vessel occlusion.

Keywords:
Cerebral infarctionCollateralEndovascular therapyOutcomesStroke

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Area of Science:

  • Neurology
  • Interventional Radiology
  • Stroke Medicine

Background:

  • Endovascular treatment (EVT) is standard for acute ischemic stroke from large vessel occlusion.
  • Patient selection for EVT trials typically uses infarct volume and penumbra, not collateral status.
  • Collateral status influences stroke progression, recanalization, and outcomes but is underused.

Approach:

  • Systematic review of recent literature on EVT outcomes based on collateral status.
  • Analysis of studies examining the predictive value of pretreatment collateral circulation.
  • Evaluation of the role of collaterals in patient selection and treatment decisions.

Key Points:

  • Pretreatment collateral status is linked to clinical and imaging outcomes after EVT for large vessel occlusion.
  • Collateral status can predict infarct growth, recanalization success, and hemorrhagic transformation.
  • Despite evidence, collateral status is not routinely incorporated into EVT treatment decisions or trial criteria.

Conclusions:

  • Collateral circulation significantly impacts EVT outcomes in acute ischemic stroke patients.
  • Current EVT trial selection criteria do not adequately incorporate collateral status.
  • Further randomized trials are necessary to integrate collateral status into EVT decision-making for large vessel occlusion.