Leptomeningeal Collateral Flow Modifies Endovascular Treatment Efficacy on Large-Vessel Occlusion Strokes

Author:

García-Tornel Álvaro1,Ciolli Ludovico2ORCID,Rubiera Marta1,Requena Manuel1,Muchada Marian1ORCID,Pagola Jorge1ORCID,Rodriguez-Luna David1,Deck Matias1,Juega Jesus1ORCID,Rodríguez-Villatoro Noelia1,Boned Sandra1,Olivé-Gadea Marta1,Sanjuan Estela1ORCID,Tomasello Alejandro3ORCID,Piñana Carlos3ORCID,Hernández David3,Álvarez-Sabin José1,Molina Carlos A.1,Ribó Marc1

Affiliation:

1. Stroke Unit, Department of Neurology (A.G.-T., M. Rubiera, M. Requena, M.M., J.P., D.R.-L, M.D., J.J., N.R.-V., S.B., M.O.-G., E.S., J.A.-S., C.A.M., M. Ribó), Hospital Vall d’Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.

2. Stroke Unit, Neurology Unit, Department of Neuroscience, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Italy (L.C.).

3. Department of Neuroradiology (A.T., C.P., D.H.), Hospital Vall d’Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.

Abstract

Background and Purpose: We aim to evaluate if good collateral flow (CF) modifies endovascular therapy (EVT) efficacy on large-vessel stroke. To do that, we used final degree of reperfusion and number of device-passes performed, factors previously associated with better functional outcome, as main outcome measures. Methods: Single-center retrospective study including consecutive stroke patients receiving EVT for anterior circulation large-vessel stroke. CF degree was assessed on CT angiography before EVT using a previously validated 4-grade score. Final degree of reperfusion, using modified Thrombolysis in Cerebral Ischemia (mTICI), and number of device-passes performed were prospectively collected. Multivariable analysis was performed to evaluate the influence of collateral flow degree on final degree of reperfusion and number of device-passes performed. Results: Six hundred twenty-six patients were included in the study; 369 patients (59%) presented good collateral flow on CT angiography. Five hundred twenty-two patients (84%) achieved successful reperfusion (mTICI 2B-3) after EVT, 304 (48%) of them with a final mTICI 2C-3. Median number of device-passes was 2 (interquartile range, 1–3). Good CF was independently associated with better final degree of reperfusion (shift analysis for mTICI0-2A/2B/2C-3%, poor CF 19/38/43 versus good CF 15/32/53, adjusted odds ratio, 1.51 [95% CI, 1.08–2.11]). Poor CF was independently associated with higher number of device-passes performed to achieve successful reperfusion (mTICI2B-3; shift analysis for 1/2/3/4+ device-passes, adjusted odds ratio, 1.59, [95% CI, 1.09–2.31]) and complete reperfusion (mTICI2C-3; shift analysis for 1/2/3/4+ device-passes, adjusted odds ratio, 1.70 [95% CI, 1.04–2.90]). Conclusions: Patients with good CF treated with EVT experience higher rates of successful reperfusion with lower number of device-passes. CF may facilitate thrombus retrieval and prevent distal embolization of clot fragments, improving device-passes efficacy.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

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