Collateral status and recanalization after endovascular treatment for acute ischemic stroke

S. M. Uniken Venema*, J. W. Dankbaar, L. Wolff, A. C. G. M. Van Es, M. Sprengers, A. Van Der Lugt, D. W. J. Dippel, H. B. Van Der Worp

*Corresponding author for this work

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Abstract

Background: Successful recanalization and good collateral status are associated with good clinical outcomes after endovascular treatment (EVT) for acute ischemic stroke, but the relationships among them are unclear. Objective: To assess if collateral status is associated with recanalization after EVT and if collateral status modifies the association between successful recanalization and functional outcome. Methods: We retrospectively analyzed data from the MR CLEAN Registry, a multicenter prospective cohort study of patients with a proximal anterior occlusion who underwent EVT in the Netherlands. We determined collateral status with a previously validated four-point visual grading scale and defined successful recanalization as an extended Thrombolysis in Cerebral Infarction score ≥2B. Functional outcome was determined using the modified Rankin Scale score at 90 days. We assessed, with multivariable logistic regression models, the associations between (1) collateral status and successful recanalization, (2) successful recanalization and functional outcome, (3) collateral status and functional outcome. An interaction of collateral status and successful recanalization was assessed. Subgroup analyses were performed for patients treated with intravenous thrombolysis. Results: We included 2717 patients, of whom 1898 (70%) had successful recanalization. There was no relationship between collateral status and successful recanalization (adjusted common OR (95% CI) of grades 1, 2, and 3 vs 0: 1.19 (0.82 to 1.72), 1.20 (0.83 to 1.75), and 1.10 (0.74 to 1.63), respectively). Successful recanalization (acOR (95% CI): 2.15 (1.84 to 2.52)) and better collateral grades (acOR (95% CI) of grades 1, 2, and 3 vs 0: 2.12 (1.47 to 3.05), 3.46 (2.43 to 4.92), and 4.16 (2.89 to 5.99), respectively) were both associated with a shift towards better functional outcome, without an interaction between collateral status and successful recanalization. Results were similar for the subgroup of thrombolysed patients. Conclusions: Collateral status is not associated with the probability of successful recanalization after EVT and does not modify the association between successful recanalization and functional outcome.

Original languageEnglish
Pages (from-to)531-538
Number of pages8
JournalJournal of NeuroInterventional Surgery
Volume15
Issue number6
Early online date18 May 2022
DOIs
Publication statusPublished - 1 Jun 2023

Bibliographical note

Funding Information:
Competing interests Simone M. Uniken Venema, Jan Willem Dankbaar, Lennard Wolff, Adriaan C. G. M. van Es, Marieke Sprengers report no disclosures; Diederik W. J. Dippel: reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences and Health, and unrestricted grants from Penumbra Inc., Stryker, Medtronic, Cerenovus and Thrombolytic Science, LLC for research, all paid to his institution; Aad van der Lugt: reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences and Health, and unrestricted grants from Penumbra Inc., Stryker, Medtronic, Cerenovus, and Thrombolytic Science, LLC for research, all paid to his institution; H. Bart van der Worp: received fees for consultation for Bayer and LivaNova, all paid to his institution.

Funding Information:
Funding The MR CLEAN Registry was partly funded by TWIN (Toegepast Wetenschappelijk Instituut voor Neuromodulatie) Foundation, Erasmus MC Medical Center, Maastricht University Medical Center, and Academic Medical Center Amsterdam. Simone M. Uniken Venema performed this work as coordinator of the trial MR ASAP, which is funded by Netherlands Cardiovascular Research Initiative, an initiative from the Dutch Heart Foundation.

Publisher Copyright:
© 2023 BMJ Publishing Group. All rights reserved.

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