Favorable Cerebral Collateral Cascades Improve Futile Recanalization by Reducing Ischemic Core Volume in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment.

IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Translational Stroke Research Pub Date : 2025-03-14 DOI:10.1007/s12975-025-01340-6
Liping Huang, Shuyu Jiang, Chen Gong, Gang Wu, Jing Guo, Jin Liu, Jinxian Yuan, You Wang, Tao Xu, Chang Liu, Shengli Chen, Yangmei Chen
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Abstract

Although endovascular treatment (EVT) was the first-line therapeutic strategy for acute ischemic stroke (AIS), half of the patients could not achieve functional independence. Previous studies suggested arterial collateral was an important predictor of this phenomenon. However, cerebral collateral circulation was regulated by arteries, venous, and microcirculation, and its role remained unclear. Therefore, based on the integrated cerebral collateral cascade (CCC) system, this study aimed to explore the relationship and potential mechanisms between CCC and futile recanalization. This was a multicenter retrospective study for AIS patients receiving EVT. The CCC model was used to comprehensively assess the collateral circulation, which consisted of arterial collaterals, venous outflow, and tissue-level collaterals. Imaging outcomes included ischemic core, hypoperfusion volume, and penumbra volume. The clinical outcome was futile recanalization, defined as a 90-day modified Rankin Scale (mRS) 3-6 after successful recanalization. Multivariate regression and mediation analyses were used to assess the relationship between CCC, futile recanalization, and potential mediators. Among 513 patients with successful recanalization, 50.6% (260) experienced futile recanalization. In the multivariable regression analysis, favorable CCC (aOR 0.48, 95% CI 0.31-0.75; P = 0.001) was independently associated with unfavorable outcome despite successful recanalization. Furthermore, mediation analysis revealed that favorable CCC significantly reduced the ischemic core accounting for 27.62% (95% CI 9.69-66.00%) of its beneficial effect on futile recanalization. The benefit of favorable CCC on futile recanalization may be mediated by a reduction in ischemic core volume in AIS patients undergoing EVT. Our findings deepen the understanding of futile recanalization and microcirculation.

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来源期刊
Translational Stroke Research
Translational Stroke Research CLINICAL NEUROLOGY-NEUROSCIENCES
CiteScore
13.80
自引率
4.30%
发文量
130
审稿时长
6-12 weeks
期刊介绍: Translational Stroke Research covers basic, translational, and clinical studies. The Journal emphasizes novel approaches to help both to understand clinical phenomenon through basic science tools, and to translate basic science discoveries into the development of new strategies for the prevention, assessment, treatment, and enhancement of central nervous system repair after stroke and other forms of neurotrauma. Translational Stroke Research focuses on translational research and is relevant to both basic scientists and physicians, including but not restricted to neuroscientists, vascular biologists, neurologists, neuroimagers, and neurosurgeons.
期刊最新文献
Favorable Cerebral Collateral Cascades Improve Futile Recanalization by Reducing Ischemic Core Volume in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment. Jugular Vein Evans Blue Injection for Blood-Brain Barrier Assessment Following Hemorrhagic Stroke in a Mouse Model. Influx of Metabolites into Cerebrospinal Fluid in Intracerebral Hemorrhage is Associated with Increased Central Inflammation: a Retrospective Observational Study. A Freely Moving Photothrombotic Stroke Model Reveals Sustained Dysfunction of GABAergic Neuron in Contralesional Cortex Using Miniaturized Two-Photon Microscopy. Stroke Mechanisms in Intracranial Atherosclerotic Disease: A Modified Classification System and Clinical Implications.
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