Association of Multimodal Collateral Profiles with Outcomes After Large Core Thrombectomy

Background/Objectives: Cerebral collateral circulation markers in large core thrombectomy and their impact on functional outcomes have not been extensively reported. Methods: We retrospectively analyzed health system medical records of large core (Alberta Stroke Program Early Computed Tomography Score <6 and/or computed tomography perfusion [CTP] cerebral blood flow <30% volume ≥50 milliliters [mL]) thrombectomy patients over a 19-month period. A good collateral profile (CCC+) was defined as the combination of computed tomography angiography Tan arterial score ≥2 and CTP cerebral blood volume index (CBVI) ≥0.8. A poor profile (CCC−) was defined as Tan <2 and CBVI <0.8. All others were categorized as having a mixed profile (CCC±). Multivariable Firth’s penalized logistic regression was used to identify factors independently associated with the primary outcome, 90-day modified Rankin Scale (mRS) 0–3. Results: 88 patients with median (interquartile range, IQR) age 65.5 (56.5–77.5) years and core volume 78 (55–116) mL were included. Forty-seven patients (53.4%) had poor collateral profiles, 31 (35.2%) were classified as CCC±, and 10 (11.4%) as CCC+. In the multivariable Firth’s penalized logistic regression model, CCC+ patients had higher odds of achieving a 90-day mRS of 0–3 compared with CCC− patients, though the difference was not statistically significant (odds ratio [OR] 1.117, 95% confidence interval [CI] 0.235–5.311, p = 0.889). No significant difference was observed between CCC± and CCC− patients (OR 0.869, 95% CI 0.293–2.577, p = 0.800). Glucose was the only factor independently associated with 90-day outcomes (OR 0.742, 95% CI 0.602–0.915, p = 0.005). Conclusions: No independent association was detected between favorable or mixed cerebral collateral circulation and 90-day mRS 0–3 after large core thrombectomy, though the study was underpowered for the CCC+ comparison. Presenting glucose may inform the likelihood of achieving independent ambulatory status at 90 days.