Good collateral circulation predicted better outcomes in severe symptomatic MCA stenosis, reducing adverse events (aOR 0.42) and improved survival (HR 0.39) at 1 year.
Does endovascular intervention improve outcomes compared to medical therapy in patients with severe symptomatic MCA stenosis, and how does collateral circulation status impact these outcomes?
In patients with severe symptomatic MCA stenosis, robust collateral circulation is a stronger independent predictor of 1-year functional independence and survival than the choice between endovascular intervention and medical therapy.
Absolute Event Rate: 0% vs 0%
This multicenter study investigated whether treatment outcomes for severe symptomatic middle cerebral artery (MCA) stenosis (≥90%) depend on collateral circulation status, given conflicting evidence on endovascular intervention versus medical therapy for intracranial atherosclerotic disease (ICAD). A retrospective cohort analysis was conducted across three Chinese tertiary centers (2017–2022), enrolling 192 patients with symptomatic MCA stenosis. Participants were stratified by ASITN/SIR collateral grades (good: 3–4; poor: 0–2) and treatment (medical vs. interventional), forming four cohorts. All received standardized medical therapy (dual antiplatelets + risk factor control); intervention groups underwent angioplasty ± stenting. Primary outcomes were functional independence (mRS ≤2 at 1 year), with secondary endpoints of stroke/death at 1 year. Statistical analyses included multivariable logistic regression (adjusting for age, sex, hypertension, diabetes) and Kaplan-Meier survival analysis. Good collaterals independently predicted better outcomes: reduced adverse events (aOR 0.42, 95% CI 0.21–0.84; p=0.014) and improved survival (HR 0.39, 95% CI 0.17–0.90; log-rank p=0.027). Perioperative complications were comparable between intervention groups (good collaterals-intervention: 4.5% vs. poor collaterals-intervention: 7.3%; p=0.935). At 1year, pooled analysis showed lower event rates with good collaterals (7% vs. 17%, RR=2.49, p=0.021), with no treatment-specific differences (good collaterals-intervention: 9.1% vs good collaterals-medical: 5.4%, p =0.696; poor collaterals-intervention: 15% vs poor collaterals-medical: 20%, p =0.590). In this multicenter retrospective cohort study, robust collateral circulation (ASITN/SIR grades 3-4) appears to be a more important independent predictor of functional independence and reduced stroke/death at 1 year than treatment modality in patients with severe symptomatic MCA stenosis.
He et al. (Sun,) reported a other. Good collateral circulation predicted better outcomes in severe symptomatic MCA stenosis, reducing adverse events (aOR 0.42) and improved survival (HR 0.39) at 1 year.
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