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Stroke. 2019 Apr;50(4):867-872. doi: 10.1161/STROKEAHA.118.022815.

Better Collaterals Are Independently Associated With Post-Thrombolysis Recanalization Before Thrombectomy.

Author information

1
From the Department of Neurology (P.S., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France.
2
Department of Radiology (P.R., L.L., W.B.H., O.N., S.L., C. Oppenheim), Sainte-Anne Hospital, INSERM U894, University Paris Descartes, France.
3
Department of Neuroradiology (J.-P.C.), Bretonneau Hospital, University of Tours, France.
4
Department of Stroke Medicine (T.-H.C.), Hospices Civils de Lyon, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, France.
5
Department of Neurology (C.A.), CHRU Gui de Chauliac, Montpellier, France.
6
Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, INSERM U947, France (S.B.).
7
Department of Neurology (C. Ozsancak), Orleans Hospital, France.
8
Department of Neurology (S.D.), Bretonneau Hospital, University of Tours, France.
9
Department of Neuroradiology (Y.B.), Hospices Civils de Lyon, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, France.
10
Department of Interventional Neuroradiology (V.C.), CHRU Gui de Chauliac, Montpellier, France.
11
Department of Neurology, University Hospital of Nancy, France (S.R.).
12
Department of Radiology (C.M.), Orleans Hospital, France.

Abstract

Background and Purpose- In acute stroke patients with large vessel occlusion, the goal of intravenous thrombolysis (IVT) is to achieve early recanalization (ER). Apart from occlusion site and thrombus length, predictors of early post-IVT recanalization are poorly known. Better collaterals might also facilitate ER, for instance, by improving delivery of the thrombolytic agent to both ends of the thrombus. In this proof-of-concept study, we tested the hypothesis that good collaterals independently predict post-IVT recanalization before thrombectomy. Methods- Patients from the registries of 6 French stroke centers with the following criteria were included: (1) acute stroke with large vessel occlusion treated with IVT and referred for thrombectomy between May 2015 and March 2017; (2) pre-IVT brain magnetic resonance imaging, including diffusion-weighted imaging, T2*, MR angiography, and dynamic susceptibility contrast perfusion-weighted imaging; and (3) ER evaluated ≤3 hours from IVT start on either first angiographic run or noninvasive imaging. A collateral flow map derived from perfusion-weighted imaging source data was automatically generated, replicating a previously validated method. Thrombus length was measured on T2*-based susceptibility vessel sign. Results- Of 224 eligible patients, 37 (16%) experienced ER. ER occurred in 10 of 83 (12%), 17 of 116 (15%), and 10 of 25 (40%) patients with poor/moderate, good, and excellent collaterals, respectively. In multivariable analysis, better collaterals were independently associated with ER ( P=0.029), together with shorter thrombus ( P<0.001) and more distal occlusion site ( P=0.010). Conclusions- In our sample of patients with stroke imaged with perfusion-weighted imaging before IVT and intended for thrombectomy, better collaterals were independently associated with post-IVT recanalization, supporting our hypothesis. These findings strengthen the idea that advanced imaging may play a key role for personalized medicine in identifying patients with large vessel occlusion most likely to benefit from IVT in the thrombectomy era.

KEYWORDS:

collateral circulation; magnetic resonance imaging; perfusion imaging; stroke; thrombectomy

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