Relationship between stroke etiology and collateral status in anterior circulation large vessel occlusion
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ORIGINAL COMMUNICATION
Relationship between stroke etiology and collateral status in anterior circulation large vessel occlusion Eva Hassler1 · Markus Kneihsl2 · Hannes Deutschmann1 · Nicole Hinteregger1 · Marton Magyar1 · Ulrike Wießpeiner1 · Melanie Haidegger2 · Simon Fandler‑Höfler2 · Sebastian Eppinger2 · Kurt Niederkorn2 · Christian Enzinger1,2 · Franz Fazekas2 · Thomas Gattringer1,2 Received: 5 March 2020 / Revised: 17 June 2020 / Accepted: 18 June 2020 © The Author(s) 2020
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 Stroke · Collateral circulation · Thrombectomy · Carotid artery diseases · Outcome
Introduction
Eva Hassler, Markus Kneihsl contributed equally to the manuscript. * Thomas Gattringer [email protected] 1
Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
2
Mechanical thrombectomy (MT) is the recommended treatment for acute ischemic stroke due to large vessel occlusion (LVO) of the anterior cerebral circulation [1]. With increasing experience and technical advances, successful recanalization can nowadays be achieved in up to 90% of all thrombectomy cases. How
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