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Collateral vessels in proximal middle cerebral artery occlusion: the ENDOSTROKE study. 2015

Oliver C Singer, and Joachim Berkefeld, and Christian H Nolte, and Georg Bohner, and Arno Reich, and Martin Wiesmann, and Klaus Groeschel, and Stephan Boor, and Tobias Neumann-Haefelin, and Erich Hofmann, and Anett Stoll, and Albrecht Bormann, and David S Liebeskind
From the Department of Neurology (O.C.S.) and Institute for Neuroradiology (J.B.), Goethe University, Schleusenweg 2-16, D-60528 Frankfurt/Main, Germany; Department of Neurology (C.H.N.) and Institute for Diagnostic and Interventional Radiology and Nuclear Medicine (G.B.), Charité Hospital, Berlin, Germany; Department of Neurology (A.R.) and Institute for Diagnostic and Interventional Neuroradiology (M.W.), University Hospital Aachen, Aachen, Germany; Department of Neurology (K.G.) and Institute for Neuroradiology (S.B.), University Hospital Mainz, Mainz, Germany; Department of Neurology (T.N.) and Institute for Diagnostic and Interventional Neuroradiology (E.H.), Klinikum Fulda, Fulda, Germany; Department of Neurology (A.S.) and Institute for Radiology (A.B.), Klinikum Altenburger Land, Altenburg, Germany; and UCLA Stroke Center and Department of Neurology, University of California-Los Angeles, Los Angeles, Calif (D.S.L.).

OBJECTIVE To determine the impact of collateral vessel status on clinical and imaging outcomes in patients undergoing endovascular therapy (EVT) for proximal middle cerebral artery (MCA) occlusion. METHODS There were 160 patients with proximal MCA occlusion at six centers in this institutional review board-approved multicenter EVT registry. Angiograms were analyzed at a blinded core laboratory, and collateral vessel status was assessed by using the American Society of Interventional and Therapeutic Neuroradiology (ASITN)/Society of Interventional Radiology (SIR) collateral vessel grading system, while reperfusion was assessed by using the Thrombolysis in Cerebral Infarction (TICI) scale. Good outcome was defined as a modified Rankin Scale score of 0-2 at follow-up. Binary logistic regression analysis was performed by using parameters with P < .2 in univariate analysis. RESULTS Good clinical outcome was attained in 62 (39%) of the 160 patients, and TICI 2b-3 reperfusion was achieved in 94 (59%) patients. Nineteen patients had ASITN/SIR collateral vessel grades of 0 or 1, 63 patients had a grade of 2, and 78 patients had grades of 3 or 4. Better collateral vessels were associated with higher reperfusion rates (21%, 48%, and 77% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P < .001), a higher proportion of infarcts smaller than one-third of the MCA territory (32%, 48%, and 69% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P < .001), and a higher proportion of good clinical outcome (11%, 35%, and 49% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P = .007). At multivariable analysis, collateral vessel status independently predicted reperfusion, final infarct size, and clinical outcome. Within an onset-to-treatment time (OTT) of 0-3 hours, collateral vessel status predicted final infarct size and reperfusion. Within an OTT of 3-6 hours, it additionally predicted clinical outcome, with 53% of patients with ASITN/SIR grades of 3 or 4 having a good outcome, as compared with 0% of patients with grades of 0 or 1 and 27% of patients with a grade of 2 (P = .008). CONCLUSIONS In this patient population, collateral vessel status independently predicted the pivotal outcome parameters of reperfusion, infarct size, and clinical outcome. These data underscore the utility of patient selection for EVT on the basis of collateral vessel status.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D012042 Registries The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. Parish Registers,Population Register,Parish Register,Population Registers,Register, Parish,Register, Population,Registers, Parish,Registers, Population,Registry
D003097 Collateral Circulation Maintenance of blood flow to an organ despite obstruction of a principal vessel. Blood flow is maintained through small vessels. Blood Circulation, Collateral,Circulation, Collateral,Collateral Blood Circulation,Collateral Circulation, Blood,Blood Collateral Circulation,Circulation, Blood Collateral,Circulation, Collateral Blood,Collateral Blood Circulations,Collateral Circulations,Collateral Circulations, Blood
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D057510 Endovascular Procedures Minimally invasive procedures, diagnostic or therapeutic, performed within the BLOOD VESSELS. They may be perfomed via ANGIOSCOPY; INTERVENTIONAL MAGNETIC RESONANCE IMAGING; INTERVENTIONAL RADIOGRAPHY; or INTERVENTIONAL ULTRASONOGRAPHY. Endovascular Techniques,Intravascular Procedures,Intravascular Techniques,Endovascular Procedure,Endovascular Technique,Intravascular Procedure,Intravascular Technique,Procedure, Endovascular,Procedure, Intravascular,Procedures, Endovascular,Procedures, Intravascular,Technique, Endovascular,Technique, Intravascular,Techniques, Endovascular,Techniques, Intravascular
D020244 Infarction, Middle Cerebral Artery NECROSIS occurring in the MIDDLE CEREBRAL ARTERY distribution system which brings blood to the entire lateral aspects of each CEREBRAL HEMISPHERE. Clinical signs include impaired cognition; APHASIA; AGRAPHIA; weak and numbness in the face and arms, contralaterally or bilaterally depending on the infarction. Cerebral Infarction, Middle Cerebral Artery,Embolic Infarction, Middle Cerebral Artery,MCA Infarct,Middle Cerebral Artery Embolus,Middle Cerebral Artery Infarction,Stroke, Middle Cerebral Artery,Thrombotic Infarction, Middle Cerebral Artery,Embolus, Middle Cerebral Artery,Left Middle Cerebral Artery Infarction,MCA Infarction,Middle Cerebral Artery Circulation Infarction,Middle Cerebral Artery Embolic Infarction,Middle Cerebral Artery Occlusion,Middle Cerebral Artery Stroke,Middle Cerebral Artery Syndrome,Middle Cerebral Artery Thrombosis,Middle Cerebral Artery Thrombotic Infarction,Occlusion, Middle Cerebral Artery,Right Middle Cerebral Artery Infarction,Thrombosis, Middle Cerebral Artery,Infarct, MCA,Infarcts, MCA,MCA Infarcts

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