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Abstract Details

Collateral Strength on CT Angiography can Predict MRI Infarct Growth, but not Clinical Outcomes in Patients Treated with Mechanical Thrombectomy
Cerebrovascular Disease and Interventional Neurology
P2 - Poster Session 2 (8:00 AM-9:00 AM)
4-006

To investigate association between collateral blood flow, infarct growth, and clinical outcomes.
Progression of penumbra to ischemic core infarct depends on collateral blood supply to that territory. Conceptually, collateral strength may be useful in predicting infarct volume growth, as well as early and long-term clinical outcomes in patients treated with mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO).
All patients presenting to a comprehensive stroke center from January 2016 to July 2019 with ELVO in the anterior circulation undergoing MT were analyzed. Infarct volumes on MRI were measured using region of interest analysis. Collateral strength was scored from 1 (<50% collateral filling of occluded territory) to 3 (100% collateral filling to occluded territory) using previously published scoring systems by investigators blinded to clinical outcome. Collateral scores were analyzed using linear regression to outcome variables of: 1) MRI infarct growth, 2) early neurological improvement (ENI), defined as 40% reduction in next day NIHSS, and 3) modified Rankin score (mRS) at 90 days.
A total of 77 patients with CT angiography as well as MRI pre and post MT were included in the analysis. In this cohort, 19 patients were assigned a collateral grade of 3, 22 a grade of 2, and 36 a grade of 1. Mean MRI infarct growth for collateral grades 3, 2, and 1 were 11.95 mL [7.23,34.51], 18.29 mL [-1.52,38.10], and 23.82 [5.90, 41.74], respectively. ENI was achieved in 47% of the grade 3 cohort, 68% of the grade 2 cohort, and 53% of the grade 1 cohort. Average 90-day mRS scores within these groups were 2.82, 2.53, and 3.17, respectively.
Although underpowered, this analysis revealed a trend towards reduced infarct growth in stronger collateral circulations. However, collateral strength was not a reliable predictor of short or long-term clinical outcomes.
Authors/Disclosures
Kristopher Southard, MD
PRESENTER 		Dr. Southard has nothing to disclose.
Bhageeradh Mulpur, MD (University of Miami/Jackson Memorial Hospital - Vascular Neurology) Dr. Mulpur has nothing to disclose.
Nirmal Andrapalliyal, MD (Cleveland Clinic) Dr. Andrapalliyal has nothing to disclose.
Sam S. Handshoe (Norton Healthcare) Dr. Handshoe has nothing to disclose.
Muhammad S. Hussain, MD (Cleveland Clinic) Dr. Hussain has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Hussain has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tiger Medical.
No disclosure on file