Collateral flow as causative of good outcomes in endovascular stroke therapy
| Autor: | Sheth, Sunil A, Sanossian, Nerses, Hao, Qing, Starkman, Sidney, Ali, Latisha K, Kim, Doojin, Gonzalez, Nestor R, Tateshima, Satoshi, Jahan, Reza, Duckwiler, Gary R, Saver, Jeffrey L, Vinuela, Fernando, Liebeskind, David S, UCLA Collateral Investigators |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Outcome Assessment Endovascular Procedures Angiography Neurosciences Collateral Circulation Middle Aged Severity of Illness Index Brain Ischemia Brain Disorders Stroke Health Care Clinical Research Cerebrovascular Circulation Blood Flow 80 and over Humans Female cardiovascular diseases UCLA Collateral Investigators Aged MRI Thrombectomy |
| Zdroj: | Journal of neurointerventional surgery, vol 8, iss 1 |
| Popis: | BackgroundEndovascular reperfusion techniques are a promising intervention for acute ischemic stroke (AIS). Prior studies have identified markers of initial injury (arrival NIH stroke scale (NIHSS) or infarct volume) as predictive of outcome after these procedures. We sought to define the role of collateral flow at the time of presentation in determining the extent of initial ischemic injury and its influence on final outcome.MethodsDemographic, clinical, laboratory, and radiographic data were prospectively collected on a consecutive cohort of patients who received endovascular therapy for acute cerebral ischemia at a single tertiary referral center from September 2004 to August 2010.ResultsHigher collateral grade as assessed by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading scheme on angiography at the time of presentation was associated with improved reperfusion rates after endovascular intervention, decreased post-procedural hemorrhage, smaller infarcts on presentation and discharge, as well as improved neurological function on arrival to the hospital, discharge, and 90 days later. Patients matched by vessel occlusion, age, and time of onset demonstrated smaller strokes on presentation and better functional and radiographic outcome if found to have superior collateral flow. In multivariate analysis, lower collateral grade independently predicted higher NIHSS on arrival.ConclusionsImproved collateral flow in patients with AIS undergoing endovascular therapy was associated with improved radiographic and clinical outcomes. Independent of age, vessel occlusion and time, in patients with comparable ischemic burdens, changes in collateral grade alone led to significant differences in initial stroke severity as well as ultimate clinical outcome. |
| Databáze: | OpenAIRE |
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