Robust Collaterals Are Independently Associated With Excellent Recanalization in Patients With Large Vessel Occlusion...

Area of Science:

• Neurology
• Interventional Neuroradiology
• Stroke Medicine

Background:

• Mechanical thrombectomy is a key treatment for acute ischemic stroke due to large vessel occlusion.
• Achieving excellent recanalization (mTICI 2c/3) improves functional outcomes compared to mTICI 2b.
• Identifying predictors of excellent recanalization is crucial for optimizing treatment strategies.

Purpose of the Study:

• To identify pretreatment and interventional factors associated with excellent recanalization (mTICI 2c/3) versus suboptimal recanalization (mTICI 2b).
• To develop a predictive model for excellent recanalization in patients undergoing mechanical thrombectomy for large vessel occlusion stroke.

Main Methods:

• Retrospective analysis of 149 patients with anterior circulation large vessel occlusion stroke treated with mechanical thrombectomy.
• Multivariate logistic regression was used to evaluate associations between clinical, imaging, and procedural parameters and mTICI 2c/3 reperfusion.
• A predictive model was constructed using identified independent factors.

Main Results:

• Lower NIH Stroke Scale scores, absence of diabetes, and absence of prior stroke were associated with excellent recanalization.
• A cerebral blood volume index ≥0.7 on CT perfusion was a strong predictor (aOR 3.75).
• Aspiration thrombectomy alone was also associated with higher likelihood of excellent recanalization (aOR 2.89).

Conclusions:

• Robust collateral status (Cerebral Blood Volume Index ≥0.7), absence of prior stroke, and absence of diabetes are independently associated with excellent recanalization.
• These findings emphasize the prognostic importance of collateral status and modifiable risk factors.
• Optimizing these factors may enhance the likelihood of successful reperfusion in stroke patients.