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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Association between collateral status and clinical outcomes in patients with acute basilar artery occlusion following
Zhaoxia Yang1, Linyu Li2,3, Haoxuan Zhu3,4
1Department of Radiology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Insights
Good collateral status in acute basilar artery occlusion (ABAO) patients undergoing endovascular therapy (EVT) significantly improves 90-day and 1-year functional outcomes and reduces mortality. Collateral status is crucial for long-term recovery but not linked to hemorrhagic complications.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Medicine
Background:
- The prognostic value of collateral circulation in acute basilar artery occlusion (ABAO) remains unclear.
- Digital subtraction angiography (DSA)-based collateral grading needs systematic evaluation for clinical outcomes in ABAO patients undergoing endovascular therapy (EVT).
Purpose of the Study:
- To assess the association between DSA-based collateral status and 90-day functional, safety, and long-term outcomes in ABAO patients treated with EVT.
- To determine the predictive value of collateral status for patient recovery after EVT for ABAO.
Main Methods:
- Utilized data from the BASILAR Registry, including 647 ABAO patients who underwent EVT.
- Assessed collateral status using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) criteria.
- Analyzed 90-day functional outcomes, safety outcomes, and long-term outcomes.
Main Results:
- Good collateral status (12.7% of patients) was linked to significantly higher odds of favorable functional outcomes at 90 days and 1 year.
- Good collateral status was associated with reduced mortality rates at 90 days and 1 year.
- Collateral status did not correlate with hemorrhagic complications but was a strong predictor of 1-year favorable outcomes.
Conclusions:
- Good collateral status predicts favorable functional outcomes in ABAO patients undergoing EVT.
- Collateral status is not associated with hemorrhagic complications but is vital for long-term recovery.
- DSA-based collateral assessment is crucial for predicting outcomes in ABAO patients treated with EVT.
Background:
The correlation between the digital subtraction angiography (DSA)-based collateral status grading system and clinical outcomes in acute basilar artery occlusion (ABAO) patients has not been systematically evaluated. This study aims to assess the role of DSA-based collateral status in relation to 90-day functional outcomes, safety outcomes, and long-term outcomes among patients with ABAO undergoing endovascular therapy (EVT).
Materials And Methods:
We used data of ABAO patients from the BASILAR (Assessment of Endovascular treatment for Acute Basilar Artery Occlusion via a nationwide Prospective Registry) Registry. Collateral status was assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) criteria. Outcomes included 90-day functional outcomes, safety outcomes and long-term outcomes.
Results:
Among 647 patients who received EVT, 12.7% (82 of 647) achieved good collateral. Compared to patients with poor collateral, good collateral was associated with higher odds of 90-day and 1-year favorable functional outcome (adjusted OR: 3.167 and 3.478, 95% CI: 1.743-5.753 and 1.798-6.731, P < 0.001) and reduced rate of mortality within 90-day and 1-year (adjusted OR: 0.218 and 0.291, 95% CI: 0.099-0.482 and 0.145-0.585, P < 0.001). Collateral status was not associated with hemorrhagic complications. The SHAP value of collateral status for predicting 90-day favorable outcomes ranked third and rose to first for 1-year favorable outcomes. There was no interaction between collateral status and any factors association with favorable functional outcome.
Conclusion:
In patients with ABAO undergoing EVT, good collateral status was associated with favorable functional outcome, while no significant correlation was found between collateral status and hemorrhagic complications. Collateral status may be crucial for the long-term recovery of patients with ABAO undergoing thrombectomy.
