Key result
Better collaterals were independently associated with early post-IVT recanalization before thrombectomy (P=0.029), occurring in 40% of patients with excellent collaterals versus 12% with poor/moderate.
Why the study?
Apart from occlusion site and thrombus length, predictors of early post-intravenous thrombolysis recanalization are poorly known, and whether good collaterals independently predict recanalization before thrombectomy was untested.
Are better collaterals associated with early post-IVT recanalization before thrombectomy in acute stroke patients with large vessel occlusion?
Observational (n=224)
Yes
Are better collaterals associated with early post-IVT recanalization before thrombectomy in acute stroke patients with large vessel occlusion?
Absolute Event Rate: 40% vs 12%
p-value: p=0.029
Better collaterals, along with shorter thrombus and more distal occlusion, independently predict early post-IVT recanalization before thrombectomy in acute stroke patients with large vessel occlusion.
Collateral status was associated with early post-IVT recanalization; hypothesis-generating and should not yet change practice in LVO stroke.
Background and Purpose- In acute stroke patients with large vessel occlusion, the goal of intravenous thrombolysis (IVT) is to achieve early recanalization (ER). Apart from occlusion site and thrombus length, predictors of early post-IVT recanalization are poorly known. Better collaterals might also facilitate ER, for instance, by improving delivery of the thrombolytic agent to both ends of the thrombus. In this proof-of-concept study, we tested the hypothesis that good collaterals independently predict post-IVT recanalization before thrombectomy. Methods- Patients from the registries of 6 French stroke centers with the following criteria were included: (1) acute stroke with large vessel occlusion treated with IVT and referred for thrombectomy between May 2015 and March 2017; (2) pre-IVT brain magnetic resonance imaging, including diffusion-weighted imaging, T2*, MR angiography, and dynamic susceptibility contrast perfusion-weighted imaging; and (3) ER evaluated ≤3 hours from IVT start on either first angiographic run or noninvasive imaging. A collateral flow map derived from perfusion-weighted imaging source data was automatically generated, replicating a previously validated method. Thrombus length was measured on T2*-based susceptibility vessel sign. Results- Of 224 eligible patients, 37 (16%) experienced ER. ER occurred in 10 of 83 (12%), 17 of 116 (15%), and 10 of 25 (40%) patients with poor/moderate, good, and excellent collaterals, respectively. In multivariable analysis, better collaterals were independently associated with ER ( P=0.029), together with shorter thrombus ( P<0.001) and more distal occlusion site ( P=0.010). Conclusions- In our sample of patients with stroke imaged with perfusion-weighted imaging before IVT and intended for thrombectomy, better collaterals were independently associated with post-IVT recanalization, supporting our hypothesis. These findings strengthen the idea that advanced imaging may play a key role for personalized medicine in identifying patients with large vessel occlusion most likely to benefit from IVT in the thrombectomy era.
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Seners et al. (2019) conducted an observational in Acute stroke with large vessel occlusion (n=224). Better collaterals (good or excellent) vs. Poor/moderate collaterals was evaluated on Early post-IVT recanalization before thrombectomy (p=0.029). Better collaterals were independently associated with early post-IVT recanalization before thrombectomy (P=0.029), occurring in 40% of patients with excellent collaterals versus 12% with poor/moderate.
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