Collateral Grade Modifies the Association Between Pretreatment Infarct Core Volume and 90-day Functional Independence...

Area of Science:

• Neurology
• Interventional Radiology
• Stroke Medicine

Background:

• Mechanical thrombectomy outcomes vary despite high reperfusion rates.
• Pretreatment infarct core volume is a key recovery determinant.
• Collateral physiology may influence the impact of infarct core volume on functional outcomes.

Purpose of the Study:

• To investigate if baseline collateral grade modifies the relationship between infarct core volume and 90-day functional independence.
• To assess prognostication in anterior circulation large-vessel occlusion (LVO) patients undergoing mechanical thrombectomy.

Main Methods:

• Retrospective observational cohort of adults undergoing mechanical thrombectomy.
• Infarct core volume quantified using MRI/CT perfusion; collaterals graded on baseline angiography (ASITN/SIR scale).
• Multivariable logistic regression analyzed core volume, collateral grade, and their interaction for 90-day functional independence (modified Rankin Scale 0-2).

Main Results:

• Successful reperfusion achieved in 91.3% of 69 patients.
• Functional independence occurred in 53.8% of anterior circulation strokes.
• Larger core volume decreased independence odds (aOR 0.79/10cc); higher collateral grade increased odds (aOR 2.24/grade).
• Significant interaction between core volume and collateral grade (aOR 1.12).

Conclusions:

• Collateral physiology significantly modifies the association between infarct core volume and recovery.
• Integrated assessment of infarct core and collateral status improves prognostication after thrombectomy for anterior circulation LVO.