The Cerebral Collateral Cascade

Author:

Faizy Tobias Djamsched,Mlynash Michael,Kabiri Reza,Christensen Soren,Kuraitis Gabriella Marie,Mader Marius M.ORCID,Flottmann Fabian,Broocks Gabriel,Lansberg Maarten G.ORCID,Albers Gregory W.,Marks Michael P.,Fiehler JensORCID,Wintermark Max,Heit Jeremy J.ORCID

Abstract

Background and ObjectivesRobust cerebral collaterals are associated with favorable outcomes in patients with acute ischemic stroke due to large vessel occlusion treated by thrombectomy. However, collateral status assessment mostly relies on single imaging biomarkers and a more comprehensive holistic approach may provide deeper insights into the biology of collateral perfusion on medical imaging. Comprehensive collateralization is defined as blood flow of cerebral arteries through the brain tissue and into draining veins. We hypothesized that a comprehensive analysis of the cerebral collateral cascade (CCC) on an arterial, tissue, and venous level would predict clinical and radiologic outcomes.MethodsThis was a multicenter retrospective cohort study of patients with acute stroke undergoing thrombectomy triage. CCC was determined by quantifying pial arterial collaterals, tissue-level collaterals, and venous outflow (VO). Pial arterial collaterals were determined by CT angiography; tissue-level collaterals were assessed on CT perfusion. VO was assessed on CT angiography using the cortical vein opacification score. Three groups were defined: CCC+ (good pial collaterals, tissue-level collaterals, and VO), CCC− (poor pial collaterals, tissue-level collaterals, and VO), and CCCmixed(the remainder of the patients). Primary outcome was functional independence (modified Rankin Scale score 0–2) at 90 days. Secondary outcome was final infarct volume.ResultsA total of 647 patients met inclusion criteria: 176 CCC+, 345 CCCmixed, and 126 CCC−. Multivariable ordinal logistic regression showed that CCC+ predicted good functional outcomes (odds ratio [OR] 18.9 [95% CI 8–44.5];p< 0.001) compared with CCC− and CCCmixed. CCCmixedpatients likely had better functional outcomes compared with CCC− patients (OR 2.5 [95% CI 1.2–5.4];p= 0.014). Quantile regression analysis (50th percentile) showed that CCC+ (β −78.5, 95% CI −96.0 to −61.1;p< 0.001) and CCCmixed(β −64.0, 95% CI −82.4 to −45.6;p< 0.001) profiles were associated with considerably lower final infarct volumes compared with CCC− profiles.DiscussionComprehensive assessment of the collateral blood flow cascade in patients with acute stroke is a strong predictor of clinical and radiologic outcomes in patients treated by thrombectomy.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical)

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3