CT angiography-based collateral flow and time to reperfusion are strong predictors of outcome in endovascular treatment of patients with stroke

Fabrizio Sallustio, Caterina Motta, Silvia Pizzuto, Marina Diomedi, Angela Giordano, Vittoria Carla D'Agostino, Domenico Samà, Salvatore Mangiafico, Valentina Saia, Jacopo Maria Legramante, Daniel Konda, Enrico Pampana, Roberto Floris, Paolo Stanzione, Roberto Gandini, Giacomo Koch

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Collateral flow (CF) is an effective predictor of outcome in acute ischemic stroke (AIS) with potential to sustain the ischemic penumbra. However, the clinical prognostic value of CF in patients with AIS undergoing mechanical thrombectomy has not been clearly established. We evaluated the relationship of CF with clinical outcomes in patients with large artery anterior circulation AIS treated with mechanical thrombectomy.

METHODS: Baseline collaterals of patients with AIS (n=135) undergoing mechanical thrombectomy were independently evaluated by CT angiography (CTA) and conventional angiography and dichotomized into poor and good CF. Multivariable analyses were performed to evaluate the predictive effect of CF on outcome and the effect of time to reperfusion on outcome based on adequacy of the collaterals.

RESULTS: Evaluation of CF was consistent by both CTA and conventional angiography (p<0.0001). A higher rate of patients with good collaterals had good functional outcome at 3-month follow-up compared with those with poor collaterals (modified Rankin Scale (mRS) 0-2: 60% vs 10%, p=0.0001). Patients with poor collaterals had a significantly higher mortality rate (mRS 6: 45% vs 8%, p=0.0001). Multivariable analyses showed that CF was the strongest predictor of outcome. Time to reperfusion had a clear effect on favorable outcome (mRS ≤2) in patients with good collaterals; in patients with poor collaterals this effect was only seen when mRS ≤3 was considered an acceptable outcome.

CONCLUSIONS: CTA is a valid tool for assessing the ability of CF to predict clinical outcome in patients with AIS treated with mechanical thrombectomy. Limiting time to reperfusion is of definite value in patients with good collaterals and also to some extent in those with poor collaterals.

Original languageEnglish
JournalJournal of NeuroInterventional Surgery
DOIs
Publication statusE-pub ahead of print - Sep 23 2016

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Reperfusion
Stroke
Thrombectomy
Therapeutics
Angiography
Computed Tomography Angiography
Arteries
Mortality

Keywords

  • Journal Article

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CT angiography-based collateral flow and time to reperfusion are strong predictors of outcome in endovascular treatment of patients with stroke. / Sallustio, Fabrizio; Motta, Caterina; Pizzuto, Silvia; Diomedi, Marina; Giordano, Angela; D'Agostino, Vittoria Carla; Samà, Domenico; Mangiafico, Salvatore; Saia, Valentina; Legramante, Jacopo Maria; Konda, Daniel; Pampana, Enrico; Floris, Roberto; Stanzione, Paolo; Gandini, Roberto; Koch, Giacomo.

In: Journal of NeuroInterventional Surgery, 23.09.2016.

Research output: Contribution to journalArticle

Sallustio, F, Motta, C, Pizzuto, S, Diomedi, M, Giordano, A, D'Agostino, VC, Samà, D, Mangiafico, S, Saia, V, Legramante, JM, Konda, D, Pampana, E, Floris, R, Stanzione, P, Gandini, R & Koch, G 2016, 'CT angiography-based collateral flow and time to reperfusion are strong predictors of outcome in endovascular treatment of patients with stroke', Journal of NeuroInterventional Surgery. https://doi.org/10.1136/neurintsurg-2016-012628
Sallustio, Fabrizio ; Motta, Caterina ; Pizzuto, Silvia ; Diomedi, Marina ; Giordano, Angela ; D'Agostino, Vittoria Carla ; Samà, Domenico ; Mangiafico, Salvatore ; Saia, Valentina ; Legramante, Jacopo Maria ; Konda, Daniel ; Pampana, Enrico ; Floris, Roberto ; Stanzione, Paolo ; Gandini, Roberto ; Koch, Giacomo. / CT angiography-based collateral flow and time to reperfusion are strong predictors of outcome in endovascular treatment of patients with stroke. In: Journal of NeuroInterventional Surgery. 2016.
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abstract = "BACKGROUND: Collateral flow (CF) is an effective predictor of outcome in acute ischemic stroke (AIS) with potential to sustain the ischemic penumbra. However, the clinical prognostic value of CF in patients with AIS undergoing mechanical thrombectomy has not been clearly established. We evaluated the relationship of CF with clinical outcomes in patients with large artery anterior circulation AIS treated with mechanical thrombectomy.METHODS: Baseline collaterals of patients with AIS (n=135) undergoing mechanical thrombectomy were independently evaluated by CT angiography (CTA) and conventional angiography and dichotomized into poor and good CF. Multivariable analyses were performed to evaluate the predictive effect of CF on outcome and the effect of time to reperfusion on outcome based on adequacy of the collaterals.RESULTS: Evaluation of CF was consistent by both CTA and conventional angiography (p<0.0001). A higher rate of patients with good collaterals had good functional outcome at 3-month follow-up compared with those with poor collaterals (modified Rankin Scale (mRS) 0-2: 60{\%} vs 10{\%}, p=0.0001). Patients with poor collaterals had a significantly higher mortality rate (mRS 6: 45{\%} vs 8{\%}, p=0.0001). Multivariable analyses showed that CF was the strongest predictor of outcome. Time to reperfusion had a clear effect on favorable outcome (mRS ≤2) in patients with good collaterals; in patients with poor collaterals this effect was only seen when mRS ≤3 was considered an acceptable outcome.CONCLUSIONS: CTA is a valid tool for assessing the ability of CF to predict clinical outcome in patients with AIS treated with mechanical thrombectomy. Limiting time to reperfusion is of definite value in patients with good collaterals and also to some extent in those with poor collaterals.",
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author = "Fabrizio Sallustio and Caterina Motta and Silvia Pizzuto and Marina Diomedi and Angela Giordano and D'Agostino, {Vittoria Carla} and Domenico Sam{\`a} and Salvatore Mangiafico and Valentina Saia and Legramante, {Jacopo Maria} and Daniel Konda and Enrico Pampana and Roberto Floris and Paolo Stanzione and Roberto Gandini and Giacomo Koch",
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TY - JOUR

T1 - CT angiography-based collateral flow and time to reperfusion are strong predictors of outcome in endovascular treatment of patients with stroke

AU - Sallustio, Fabrizio

AU - Motta, Caterina

AU - Pizzuto, Silvia

AU - Diomedi, Marina

AU - Giordano, Angela

AU - D'Agostino, Vittoria Carla

AU - Samà, Domenico

AU - Mangiafico, Salvatore

AU - Saia, Valentina

AU - Legramante, Jacopo Maria

AU - Konda, Daniel

AU - Pampana, Enrico

AU - Floris, Roberto

AU - Stanzione, Paolo

AU - Gandini, Roberto

AU - Koch, Giacomo

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2016/9/23

Y1 - 2016/9/23

N2 - BACKGROUND: Collateral flow (CF) is an effective predictor of outcome in acute ischemic stroke (AIS) with potential to sustain the ischemic penumbra. However, the clinical prognostic value of CF in patients with AIS undergoing mechanical thrombectomy has not been clearly established. We evaluated the relationship of CF with clinical outcomes in patients with large artery anterior circulation AIS treated with mechanical thrombectomy.METHODS: Baseline collaterals of patients with AIS (n=135) undergoing mechanical thrombectomy were independently evaluated by CT angiography (CTA) and conventional angiography and dichotomized into poor and good CF. Multivariable analyses were performed to evaluate the predictive effect of CF on outcome and the effect of time to reperfusion on outcome based on adequacy of the collaterals.RESULTS: Evaluation of CF was consistent by both CTA and conventional angiography (p<0.0001). A higher rate of patients with good collaterals had good functional outcome at 3-month follow-up compared with those with poor collaterals (modified Rankin Scale (mRS) 0-2: 60% vs 10%, p=0.0001). Patients with poor collaterals had a significantly higher mortality rate (mRS 6: 45% vs 8%, p=0.0001). Multivariable analyses showed that CF was the strongest predictor of outcome. Time to reperfusion had a clear effect on favorable outcome (mRS ≤2) in patients with good collaterals; in patients with poor collaterals this effect was only seen when mRS ≤3 was considered an acceptable outcome.CONCLUSIONS: CTA is a valid tool for assessing the ability of CF to predict clinical outcome in patients with AIS treated with mechanical thrombectomy. Limiting time to reperfusion is of definite value in patients with good collaterals and also to some extent in those with poor collaterals.

AB - BACKGROUND: Collateral flow (CF) is an effective predictor of outcome in acute ischemic stroke (AIS) with potential to sustain the ischemic penumbra. However, the clinical prognostic value of CF in patients with AIS undergoing mechanical thrombectomy has not been clearly established. We evaluated the relationship of CF with clinical outcomes in patients with large artery anterior circulation AIS treated with mechanical thrombectomy.METHODS: Baseline collaterals of patients with AIS (n=135) undergoing mechanical thrombectomy were independently evaluated by CT angiography (CTA) and conventional angiography and dichotomized into poor and good CF. Multivariable analyses were performed to evaluate the predictive effect of CF on outcome and the effect of time to reperfusion on outcome based on adequacy of the collaterals.RESULTS: Evaluation of CF was consistent by both CTA and conventional angiography (p<0.0001). A higher rate of patients with good collaterals had good functional outcome at 3-month follow-up compared with those with poor collaterals (modified Rankin Scale (mRS) 0-2: 60% vs 10%, p=0.0001). Patients with poor collaterals had a significantly higher mortality rate (mRS 6: 45% vs 8%, p=0.0001). Multivariable analyses showed that CF was the strongest predictor of outcome. Time to reperfusion had a clear effect on favorable outcome (mRS ≤2) in patients with good collaterals; in patients with poor collaterals this effect was only seen when mRS ≤3 was considered an acceptable outcome.CONCLUSIONS: CTA is a valid tool for assessing the ability of CF to predict clinical outcome in patients with AIS treated with mechanical thrombectomy. Limiting time to reperfusion is of definite value in patients with good collaterals and also to some extent in those with poor collaterals.

KW - Journal Article

U2 - 10.1136/neurintsurg-2016-012628

DO - 10.1136/neurintsurg-2016-012628

M3 - Article

C2 - 27663559

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

ER -