CTA Collateral Status and Response to Recanalization in Patients with Acute Ischemic Stroke

Abstract

BACKGROUND AND PURPOSE: Collateral status at baseline is an independent determinant of clinical outcome among patients with\nacute ischemic stroke. We sought to identify whether the association between recanalization after intra-arterial acute stroke therapy and\nfavorable clinical response is modified by the presence of good collateral flow assessed on baseline CTA.\nMATERIALS AND METHODS: Data are from the Keimyung Stroke Registry, a prospective cohort study of patients with acute ischemic\nstroke from Daegu, South Korea. Patients with M1 segment MCA with or without intracranial ICA occlusions on baseline CTA from May\n2004 to July 2009 who also had baseline MR imaging were included. Two readers blinded to all clinical information assessed baseline and\nfollow-up imaging. Leptomeningeal collaterals on baseline CTA were assessed by consensus by use of the regional leptomeningeal score.\nRESULTS: Among 84 patients (mean age, 65.2 13.2 years; median NIHSS score, 14; interquartile range, 8.5), median time from stroke onset\nto initial MR imaging was 164 minutes. TICI 2b–3 recanalization was achieved in 38.1% of patients and mRS 0–2 at 90 days in 35.8% of\npatients. In a multivariable model, the interaction between collateral status and recanalization was significant. Only patients with intermediate\nor good collaterals who recanalized showed a statistically significant association with good clinical outcome (rate ratio 3.8; 95%\nCI, 1.2–12.1). Patients with good and intermediate collaterals who did not achieve recanalization and patients with poor collaterals, even if\nthey achieved recanalization, did not do well.\nCONCLUSIONS: Patients with good or intermediate collaterals on CTA benefit from intra-arterial therapy, whereas patients with poor\ncollaterals do not benefit from treatment.\nABBREVIATIONS: IAT intra-arterial therapy; rLMC regional leptomeningeal collateral score; SD standard deviation

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Affiliated Institutions

• University of Calgary CA
• King Abdulaziz University SA
• Keimyung University KR
• Neurology, Inc US

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