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. 2020 Nov;267(11):3362-3370.
doi: 10.1007/s00415-020-10009-z. Epub 2020 Jun 25.

Relationship between stroke etiology and collateral status in anterior circulation large vessel occlusion

Eva Hassler  1 , Markus Kneihsl  2 , Hannes Deutschmann  1 , Nicole Hinteregger  1 , Marton Magyar  1 , Ulrike Wießpeiner  1 , Melanie Haidegger  2 , Simon Fandler-Höfler  2 , Sebastian Eppinger  2 , Kurt Niederkorn  2 , Christian Enzinger  1   2 , Franz Fazekas  2 , Thomas Gattringer  3   4
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Relationship between stroke etiology and collateral status in anterior circulation large vessel occlusion

Eva Hassler et al. J Neurol. 2020 Nov.

Abstract

Background and purpose: Clinical outcome after mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke is influenced by the intracerebral collateral status. We tested the hypothesis that patients with preexisting ipsilateral extracranial carotid artery stenosis (CAS) would have a better collateral status compared to non-CAS patients. Additionally, we evaluated MT-related adverse events and outcome for both groups.

Methods: Over a 7-year period, we identified all consecutive anterior circulation MT patients (excluding extracranial carotid artery occlusion and dissection). Patients were grouped into those with CAS ≥ 50% according to the NASCET criteria and those without significant carotid stenosis (non-CAS). Collateral status was rated on pre-treatment CT- or MR-angiography according to the Tan Score. Furthermore, we assessed postinterventional infarct size, adverse events and functional outcome at 90 days.

Results: We studied 281 LVO stroke patients, comprising 46 (16.4%) with underlying CAS ≥ 50%. Compared to non-CAS stroke patients (n = 235), patients with CAS-related stroke more often had favorable collaterals (76.1% vs. 46.0%). Recanalization rates were comparable between both groups. LVO stroke patients with underlying CAS more frequently had adverse events after MT (19.6% vs. 6.4%). Preexisting CAS was an independent predictor for favorable collateral status in multivariable models (Odds ratio: 3.3, p = 0.002), but post-interventional infarct size and functional 90-day outcome were not different between CAS and non-CAS patients.

Conclusions: Preexisting CAS ≥ 50% was associated with better collateral status in LVO stroke patients. However, functional 90-day outcome was independent from CAS, which could be related to a higher rate of adverse events.

Keywords: Carotid artery diseases; Collateral circulation; Outcome; Stroke; Thrombectomy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

All authors have read and approved the submitted manuscript, which has not been submitted elsewhere nor published elsewhere in whole or in part. No author reported a relevant conflict of interest relating to this paper.

Figures

Fig. 1
Fig. 1
Flow diagram of included study participants
Fig. 2
Fig. 2
Exemplary cases of acute LVO stroke patients with good and poor collaterals. a Shows left sided hyperdense media sign (arrow) on preinterventional CT scan of a patient with acute occlusion of the M1 segment of the middle cerebral artery without an indication of ipsilateral carotid artery stenosis (b). Intracranial CT angiography (CTA) displays unfavorable collateral status according to a Tan collateral score of 0 before thrombectomy (c, arrows). Another patient presents with acute left sided atheroembolic M1 occlusion (d, arrow) and high-grade extracranial carotid artery stenosis on preinterventional CTA, which is demonstrated in e (arrow). f shows favorable collaterals according to a Tan collateral score of 3 (arrows)
See this image and copyright information in PMC

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