Greater infarct growth limiting effect of mechanical thrombectomy in stroke patients with poor collaterals
| Autor: | Victor Obach, Xabier Urra, Arturo Renú, Federico Zarco, Napoleon Macias, Carmen Montejo, Yashu Zhao, Ángel Chamorro, Laura Llull, Mariano Werner, Sergio Amaro, Carlos Laredo, Juan Macho, Salvatore Rudilosso |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Computed Tomography Angiography Infarction Collateral Circulation Perfusion scanning 030204 cardiovascular system & hematology Single Center Magnetic resonance angiography Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Prospective Studies Registries Stroke Aged Thrombectomy Aged 80 and over medicine.diagnostic_test business.industry General Medicine Cerebral Infarction Middle Aged medicine.disease Collateral circulation Cerebral Angiography Treatment Outcome Angiography Cohort Cardiology Surgery Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurointerventional surgery. 11(10) |
| ISSN: | 1759-8486 |
| Popis: | ObjectiveStroke patients with good collateral circulation achieve the best recovery after mechanical thrombectomy (MT) but strict imaging selection may result in untreated patients that could benefit from MT. We assessed whether the extent of collaterals had modifying effects on the amount of ischemic tissue saved from infarction with MT over best medical treatment (BMT).MethodsThis was a single center cohort of consecutive patients (n=339) with proximal occlusions in the carotid territory. Patients were categorized according to a four point category scale on CT angiography as having good (scores 2–3) or poor (scores 0–1) collaterals. The primary outcome measure was the interaction between collaterals and MT on infarct growth. The secondary outcome assessed the treatment effect of MT over BMT on functional status in relation to collateral status. Safety outcomes were mortality and symptomatic intracranial hemorrhage.ResultsCollaterals had a modifying effect of MT on infarct growth (P=0.004), with a greater reduction in 96 patients with poor collaterals (38.8 mL) than in 243 patients with good collaterals (1.9 mL). There was also a significant (PConclusionCompared with BMT, the use of MT in the early time window in large vessel stroke results in a more substantial limitation of infarct growth in patients with poor collaterals. |
| Databáze: | OpenAIRE |
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