Impact of Collateral Circulation on Futile Endovascular Thrombectomy in Acute Anterior Circulation Ischemic Stroke.

IF 1.4 4区 医学 Q4 CLINICAL NEUROLOGY Journal of Korean Neurosurgical Society Pub Date : 2024-01-01 Epub Date: 2023-08-03 DOI:10.3340/jkns.2023.0139
Yoo Sung Jeon, Hyun Jeong Kim, Hong Gee Roh, Taek-Jun Lee, Jeong Jin Park, Sang Bong Lee, Hyung Jin Lee, Jin Tae Kwak, Ji Sung Lee, Hee Jong Ki
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Abstract

Objective: Collateral circulation is associated with the differential treatment effect of endovascular thrombectomy (EVT) in acute ischemic stroke. We aimed to verify the ability of the collateral map to predict futile EVT in patients with acute anterior circulation ischemic stroke.

Methods: This secondary analysis of a prospective observational study included data from participants underwent EVT for acute ischemic stroke due to occlusion of the internal carotid artery and/or the middle cerebral artery within 8 hours of symptom onset. Multiple logistic regression analyses were conducted to identify independent predictors of futile recanalization (modified Rankin scale score at 90 days of 4-6 despite of successful reperfusion).

Results: In a total of 214 participants, older age (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.56 to 3.67; p<0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR, 1.12; 95% CI, 1.04 to 1.21; p=0.004), very poor collateral perfusion grade (OR, 35.09; 95% CI, 3.50 to 351.33; p=0.002), longer door-to-puncture time (OR, 1.08; 95% CI, 1.02 to 1.14; p=0.009), and failed reperfusion (OR, 3.73; 95% CI, 1.30 to 10.76; p=0.015) were associated with unfavorable functional outcomes. In 184 participants who achieved successful reperfusion, older age (OR, 2.30; 95% CI, 1.44 to 3.67; p<0.001), higher baseline NIHSS scores (OR, 1.12; 95% CI, 1.03 to 1.22; p=0.006), very poor collateral perfusion grade (OR, 4.96; 95% CI, 1.42 to 17.37; p=0.012), and longer door-to-reperfusion time (OR, 1.09; 95% CI, 1.03 to 1.15; p=0.003) were associated with unfavorable functional outcomes.

Conclusion: The assessment of collateral perfusion status using the collateral map can predict futile EVT, which may help select ineligible patients for EVT, thereby potentially reducing the rate of futile EVT.

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侧支循环对急性前循环缺血性脑卒中血管内血栓切除术失败的影响
目的:侧支循环与急性缺血性卒中血管内血栓切除术(EVT)的不同治疗效果有关。我们旨在验证侧支循环图预测急性前循环缺血性卒中患者 EVT 无效的能力:这项前瞻性观察研究的二次分析包括因颈内动脉和/或大脑中动脉闭塞导致的急性缺血性卒中而在症状出现后 8 小时内接受 EVT 的参与者的数据。研究人员进行了多元逻辑回归分析,以确定无用再通的独立预测因素(尽管再灌注成功,但在4-6天后的90天内仍有改良Rankin量表评分):结果:在总共 214 名参与者中,年龄较大(几率比 [OR],2.40;95% 置信区间 [CI],1.56 至 3.67;P使用侧支地图评估侧支灌注状态可预测EVT无效,这有助于选择不符合EVT条件的患者,从而有可能降低EVT无效率。
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来源期刊
CiteScore
2.90
自引率
6.20%
发文量
109
审稿时长
3-8 weeks
期刊介绍: The Journal of Korean Neurosurgical Society (J Korean Neurosurg Soc) is the official journal of the Korean Neurosurgical Society, and published bimonthly (1st day of January, March, May, July, September, and November). It launched in October 31, 1972 with Volume 1 and Number 1. J Korean Neurosurg Soc aims to allow neurosurgeons from around the world to enrich their knowledge of patient management, education, and clinical or experimental research, and hence their professionalism. This journal publishes Laboratory Investigations, Clinical Articles, Review Articles, Case Reports, Technical Notes, and Letters to the Editor. Our field of interest involves clinical neurosurgery (cerebrovascular disease, neuro-oncology, skull base neurosurgery, spine, pediatric neurosurgery, functional neurosurgery, epilepsy, neuro-trauma, and peripheral nerve disease) and laboratory work in neuroscience.
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