Association of leptomeningeal collateral status with clinical outcomes after endovascular thrombectomy in large-core infarction
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A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model
Published on: June 4, 2021
Hetai Lai1, Shitao Fan2, Kewei Liu3
1Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
Insights
Good leptomeningeal collateral status in stroke patients undergoing endovascular thrombectomy significantly improves functional outcomes and reduces mortality. This finding holds true regardless of reperfusion success, highlighting its prognostic importance.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Leptomeningeal collateral status is crucial in acute ischemic stroke but its prognostic value in large-core infarction treated with endovascular thrombectomy (EVT) is not fully understood.
- The Careggi Collateral Score (CCS) provides a standardized method for assessing leptomeningeal collaterals.
Purpose of the Study:
- To evaluate the impact of leptomeningeal collateral status, assessed by the CCS, on outcomes in patients with acute large-core infarction undergoing EVT.
- To determine if collateral status influences functional outcomes, mortality, and hemorrhage risk.
Main Methods:
- A post hoc analysis of a prospective multicenter cohort of patients with acute anterior circulation large-core infarction (Alberta Stroke Program Early CT Score [ASPECTS] 0-5) treated with EVT.
- Leptomeningeal collaterals were assessed using the CCS and categorized as poor (0-2) or good (3-4).
- The primary outcome was favorable functional outcome (modified Rankin Scale [mRS] score 0-3) at 90 days.
Main Results:
- Among 490 patients, 134 (27.3%) had good collateral status.
- Good collateral status was significantly associated with higher rates of favorable functional outcome (63.4% vs 27.0%) and reduced mortality (18.7% vs 50.6%).
- Good collateral status was also linked to a lower risk of symptomatic intracranial hemorrhage (6.0% vs 16.0%) but not associated with successful reperfusion.
Conclusions:
- Good leptomeningeal collateral status is a significant positive prognostic indicator in patients with acute large-core infarction treated with EVT.
- These findings suggest that collateral status independently predicts better functional outcomes, lower mortality, and reduced hemorrhage risk.
- The prognostic value of collateral status was consistent regardless of successful reperfusion.
Background:
The prognostic significance of leptomeningeal collateral status in patients with acute large-core infarction undergoing endovascular thrombectomy (EVT) remains incompletely defined. We aimed to evaluate its impact using the Careggi Collateral Score (CCS).
Methods:
This post hoc analysis of a prospective multicenter cohort included patients with acute anterior circulation large-core infarction (Alberta Stroke Program Early CT Score [ASPECTS] 0-5) treated with EVT. Leptomeningeal collaterals were assessed on digital subtraction angiography using the CCS and categorized as poor (0-2) or good (3-4). The primary outcome was favorable functional outcome (modified Rankin Scale (mRS) score 0-3) at 90 days.
Results:
Among 490 patients, 134 (27.3%) had good collateral status. Good collateral status was associated with higher rates of favorable functional outcome (63.4% vs 27.0%; adjusted odds ratio (aOR), 3.08; 95% CI, 1.94-4.88; P < 0.01) and reduced mortality (18.7% vs 50.6%; aOR, 0.37; 95% CI, 0.22-0.63; P < 0.01). Good collateral status also was linked to lower risk of symptomatic intracranial hemorrhage (6.0% vs 16.0%; aOR, 0.44; 95% CI, 0.19-0.98; P = 0.04), but was not associated with successful reperfusion.
Conclusion:
In this cohort of patients with acute large-core infarction undergoing EVT, good leptomeningeal collateral status was associated with improved functional outcomes, reduced mortality, and lower hemorrhage risk, and these associations did not differ significantly by reperfusion success.
