Abstract
Identification of patients with acute ischaemic stroke who could most benefit from arterial recanalization after endovascular treatment remains an unsettled issue. Although several classifications of collateral circulation have been proposed, the clinical role of collaterals is still debated. We evaluated the effect of the collateral circulation in relation to recanalization as a predictor of clinical outcome. Data were prospectively collected from 103 patients consecutively treated for proximal middle cerebral or internal carotid artery occlusion. The collateral circulation was evaluated with a novel semiquantitative-qualitative score, the Careggi collateral score (CCS), in six grades. Both CCS and recanalization grades (TICI) were analysed in relation to clinical outcome. A statistical analysis was performed to evaluate the effect of interaction between recanalization and collateral circulation on clinical outcome. Out of the 103 patients, 37 (36.3%) had poor collaterals, and 65 (63.7%) had good collaterals. Patients with good collaterals had lower basal National Institute of Health Stroke Scale (NIHSS), more distal occlusion, smaller lesions at 24h CT scan and better functional outcome. After multivariate analysis, the interaction between recanalization and collateral grades was significantly stronger as a predictor of good outcome (OR 6.87, 95% CI 2.11-22.31) or death (OR 4.66, 95%CI 1.48-14.73) compared to the effect of the single variables. Collaterals showed an effect of interaction with the recanalization grade in determining a favourable clinical outcome. Assessment of the collateral circulation might help predict clinical results after recanalization in patients undergoing endovascular treatment for acute ischaemic stroke.
| Original language | English |
|---|---|
| Pages (from-to) | 704-714 |
| Number of pages | 11 |
| Journal | Interventional Neuroradiology |
| Volume | 20 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Nov 1 2014 |
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Keywords
- Acute stroke
- Acute stroke intervention
- Angiography
- Collaterals
- Endovascular treatment
- Outcome
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Clinical Neurology
- Cardiology and Cardiovascular Medicine
Cite this
Effect of the interaction between recanalization and collateral circulation on functional outcome in acute ischaemic stroke. / Mangiafico, Salvatore; Saia, Valentina; Nencini, Patrizia; Romani, Ilaria; Palumbo, Vanessa; Pracucci, Giovanni; Consoli, Arturo; Rosi, Andrea; Renieri, Leonardo; Nappini, Sergio; Limbucci, Nicola; Inzitari, Domenico; Gensini, Gian Franco.
In: Interventional Neuroradiology, Vol. 20, No. 6, 01.11.2014, p. 704-714.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Effect of the interaction between recanalization and collateral circulation on functional outcome in acute ischaemic stroke
AU - Mangiafico, Salvatore
AU - Saia, Valentina
AU - Nencini, Patrizia
AU - Romani, Ilaria
AU - Palumbo, Vanessa
AU - Pracucci, Giovanni
AU - Consoli, Arturo
AU - Rosi, Andrea
AU - Renieri, Leonardo
AU - Nappini, Sergio
AU - Limbucci, Nicola
AU - Inzitari, Domenico
AU - Gensini, Gian Franco
PY - 2014/11/1
Y1 - 2014/11/1
N2 - Identification of patients with acute ischaemic stroke who could most benefit from arterial recanalization after endovascular treatment remains an unsettled issue. Although several classifications of collateral circulation have been proposed, the clinical role of collaterals is still debated. We evaluated the effect of the collateral circulation in relation to recanalization as a predictor of clinical outcome. Data were prospectively collected from 103 patients consecutively treated for proximal middle cerebral or internal carotid artery occlusion. The collateral circulation was evaluated with a novel semiquantitative-qualitative score, the Careggi collateral score (CCS), in six grades. Both CCS and recanalization grades (TICI) were analysed in relation to clinical outcome. A statistical analysis was performed to evaluate the effect of interaction between recanalization and collateral circulation on clinical outcome. Out of the 103 patients, 37 (36.3%) had poor collaterals, and 65 (63.7%) had good collaterals. Patients with good collaterals had lower basal National Institute of Health Stroke Scale (NIHSS), more distal occlusion, smaller lesions at 24h CT scan and better functional outcome. After multivariate analysis, the interaction between recanalization and collateral grades was significantly stronger as a predictor of good outcome (OR 6.87, 95% CI 2.11-22.31) or death (OR 4.66, 95%CI 1.48-14.73) compared to the effect of the single variables. Collaterals showed an effect of interaction with the recanalization grade in determining a favourable clinical outcome. Assessment of the collateral circulation might help predict clinical results after recanalization in patients undergoing endovascular treatment for acute ischaemic stroke.
AB - Identification of patients with acute ischaemic stroke who could most benefit from arterial recanalization after endovascular treatment remains an unsettled issue. Although several classifications of collateral circulation have been proposed, the clinical role of collaterals is still debated. We evaluated the effect of the collateral circulation in relation to recanalization as a predictor of clinical outcome. Data were prospectively collected from 103 patients consecutively treated for proximal middle cerebral or internal carotid artery occlusion. The collateral circulation was evaluated with a novel semiquantitative-qualitative score, the Careggi collateral score (CCS), in six grades. Both CCS and recanalization grades (TICI) were analysed in relation to clinical outcome. A statistical analysis was performed to evaluate the effect of interaction between recanalization and collateral circulation on clinical outcome. Out of the 103 patients, 37 (36.3%) had poor collaterals, and 65 (63.7%) had good collaterals. Patients with good collaterals had lower basal National Institute of Health Stroke Scale (NIHSS), more distal occlusion, smaller lesions at 24h CT scan and better functional outcome. After multivariate analysis, the interaction between recanalization and collateral grades was significantly stronger as a predictor of good outcome (OR 6.87, 95% CI 2.11-22.31) or death (OR 4.66, 95%CI 1.48-14.73) compared to the effect of the single variables. Collaterals showed an effect of interaction with the recanalization grade in determining a favourable clinical outcome. Assessment of the collateral circulation might help predict clinical results after recanalization in patients undergoing endovascular treatment for acute ischaemic stroke.
KW - Acute stroke
KW - Acute stroke intervention
KW - Angiography
KW - Collaterals
KW - Endovascular treatment
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=84930018119&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84930018119&partnerID=8YFLogxK
U2 - 10.15274/INR-2014-10069
DO - 10.15274/INR-2014-10069
M3 - Article
AN - SCOPUS:84930018119
VL - 20
SP - 704
EP - 714
JO - Interventional Neuroradiology
JF - Interventional Neuroradiology
SN - 1591-0199
IS - 6
ER -