Anadani Mohammad, Finitsis Stephanos, Clarençon Frédéric, Richard Sébastien, Marnat Gaultier, Bourcier Romain, Sibon Igor, Dargazanli Cyril, Arquizan Caroline, Blanc Raphael, Lapergue Bertrand, Consoli Arturo, Eugene Francois, Vannier Stephane, Spelle Laurent, Denier Christian, Boulanger Marion, Gauberti Maxime, Liebeskind David S, de Havenon Adam, Saleme Suzana, Macian Francisco, Rosso Charlotte, Naggara Olivier, Turc Guillaume, Ozkul-Wermester Ozlem, Papagiannaki Chrisanthi, Viguier Alain, Cognard Christophe, Le Bras Anthony, Evain Sarah, Wolff Valerie, Pop Raoul, Timsit Serge, Gentric Jean-Christophe, Bourdain Frédéric, Veunac Louis, Maier Benjamin, Gory Benjamin
Department of Neurology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
Neurology, Neurosurgery, Medical University of South Carolina,College of Medicine, Charleston, South Carolina, USA.
J Neurointerv Surg. 2022 Jun;14(6):551-557. doi: 10.1136/neurintsurg-2021-017553. Epub 2021 Jun 17.
Studies have suggested that collateral status modifies the effect of successful reperfusion on functional outcome after endovascular therapy (EVT). We aimed to assess the association between collateral status and EVT outcomes and to investigate whether collateral status modified the effect of successful reperfusion on EVT outcomes.
We used data from the ongoing, prospective, multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry. Collaterals were graded according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) guidelines. Patients were divided into two groups based on angiographic collateral status: poor (grade 0-2) versus good (grade 3-4) collaterals.
Among 2020 patients included in the study, 959 (47%) had good collaterals. Good collaterals were associated with favorable outcome (90-day modified Rankin Scale (mRS) 0-2) (OR 1.5, 95% CI 1.19 to 1.88). Probability of good outcome decreased with increased time from onset to reperfusion in both good and poor collateral groups. Successful reperfusion was associated with higher odds of favorable outcome in good collaterals (OR 6.01, 95% CI 3.27 to 11.04) and poor collaterals (OR 5.65, 95% CI 3.32 to 9.63) with no significant interaction. Similarly, successful reperfusion was associated with higher odds of excellent outcome (90-day mRS 0-1) and lower odds of mortality in both groups with no significant interaction. The benefit of successful reperfusion decreased with time from onset in both groups, but the curve was steeper in the poor collateral group.
Collateral status predicted functional outcome after EVT. However, collateral status on the pretreatment angiogram did not decrease the clinical benefit of successful reperfusion.
研究表明，侧支循环状态会改变血管内治疗（EVT）后成功再灌注对功能结局的影响。我们旨在评估侧支循环状态与EVT结局之间的关联，并研究侧支循环状态是否会改变成功再灌注对EVT结局的影响。
我们使用了正在进行的前瞻性多中心缺血性卒中血管内治疗（ETIS）登记处的数据。根据美国介入和治疗神经放射学会/介入放射学会（ASITN/SIR）指南对侧支循环进行分级。根据血管造影侧支循环状态将患者分为两组：差（0-2级）与好（3-4级）侧支循环。
在纳入研究的2020例患者中，959例（47%）侧支循环良好。侧支循环良好与良好结局（90天改良Rankin量表（mRS）0-2）相关（OR 1.5，95%CI 1.19至1.88）。在侧支循环良好和差的两组中，从发病到再灌注时间越长，良好结局的概率越低。成功再灌注与侧支循环良好组（OR 6.01，95%CI 3.27至11.04）和侧支循环差组（OR 5.65，95%CI 3.32至9.63）良好结局的较高几率相关，无显著交互作用。同样，成功再灌注与两组中优异结局（90天mRS 0-1）的较高几率和较低死亡率相关（无显著交互作用）。两组中成功再灌注的益处均随着发病时间的延长而降低，但在侧支循环差的组中曲线更陡。
侧支循环状态可预测EVT后的功能结局。然而，治疗前血管造影的侧支循环状态并未降低成功再灌注的临床益处。
