Collateral Circulation Outweighs Therapeutic Modality in Predicting Outcomes of Symptomatic MCA Stenosis: A
Guoyong He1, Hun Feng2, Shaofa Li3
1Jinan University, Guangzhou, China; Department of Neurology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China; Guangxi Academy of Medical Science, Nanning, China.
Insights
Good collateral circulation is key for better outcomes in severe symptomatic middle cerebral artery (MCA) stenosis. This factor, not treatment type, independently predicts functional independence and reduces stroke risk.
Area of Science:
- Neurology
- Cardiovascular Research
- Medical Interventions
Background:
- Investigating treatment outcomes for severe symptomatic middle cerebral artery (MCA) stenosis (≥90%).
- Examining the role of collateral circulation status in intracranial atherosclerotic disease (ICAD).
- Addressing conflicting evidence on endovascular intervention versus medical therapy.
Purpose of the Study:
- To determine if treatment outcomes for severe symptomatic MCA stenosis depend on collateral circulation.
- To compare functional independence and stroke/death rates based on collateral status and treatment modality.
Main Methods:
- Retrospective cohort analysis of 192 patients across three Chinese tertiary centers (2017-2022).
- Stratification by ASITN/SIR collateral grades (good: 3-4; poor: 0-2) and treatment (medical vs. interventional).
- Primary outcome: functional independence (mRS ≤2 at 1 year); secondary outcomes: stroke/death at 1 year. Multivariable logistic regression and Kaplan-Meier analysis were used.
Main Results:
- Good collaterals independently predicted better outcomes, including reduced adverse events (aOR 0.42) and improved survival (HR 0.39).
- Pooled analysis showed lower event rates with good collaterals (7% vs. 17%).
- No significant treatment-specific differences in outcomes were observed within collateral groups.
Conclusions:
- Robust collateral circulation is a more important independent predictor of functional independence and reduced stroke/death than treatment modality.
- Findings suggest collateral status significantly influences outcomes in severe symptomatic MCA stenosis.
- This highlights the critical role of assessing collateral circulation in managing ICAD.
Background:
This multicenter study investigated whether treatment outcomes for severe symptomatic middle cerebral artery (MCA) stenosis (≥90%) depend on collateral circulation status, given conflicting evidence on endovascular intervention versus medical therapy for intracranial atherosclerotic disease (ICAD).
Methods:
A retrospective cohort analysis was conducted across three Chinese tertiary centers (2017-2022), enrolling 192 patients with symptomatic MCA stenosis. Participants were stratified by ASITN/SIR collateral grades (good: 3-4; poor: 0-2) and treatment (medical vs. interventional), forming four cohorts. All received standardized medical therapy (dual antiplatelets+risk factor control); intervention groups underwent angioplasty±stenting. Primary outcomes were functional independence (mRS ≤2 at 1 year), with secondary endpoints of stroke/death at 1 year. Statistical analyses included multivariable logistic regression (adjusting for age, sex, hypertension, diabetes) and Kaplan-Meier survival analysis.
Results:
Good collaterals independently predicted better outcomes: reduced adverse events (aOR 0.42, 95% CI 0.21-0.84; P = 0.014) and improved survival (HR 0.39, 95% CI 0.17-0.90; log-rank P = 0.027). Perioperative complications were comparable between intervention groups (good collaterals-intervention: 4.5% vs. poor collaterals-intervention: 7.3%; P = 0.935). At 1 year, pooled analysis showed lower event rates with good collaterals (7% vs. 17%, RR=2.49, P = 0.021), with no treatment-specific differences (good collaterals-intervention: 9.1% vs. good collaterals-medical: 5.4%, P = 0.696; poor collaterals-intervention: 15% vs. poor collaterals-medical: 20%, P = 0.590).
Conclusions:
In this multicenter retrospective cohort study, robust collateral circulation (ASITN/SIR grades 3-4) appears to be a more important independent predictor of functional independence and reduced stroke/death at 1 year than treatment modality in patients with severe symptomatic MCA stenosis.
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