Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea.
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Transl Stroke Res. 2023 Feb;14(1):22-37. doi: 10.1007/s12975-022-01046-z. Epub 2022 Jun 10.
Endovascular treatment (EVT) using novel mechanical thrombectomy devices has been the gold standard for patients with acute ischemic stroke caused by large vessel occlusion. Selection criteria of randomized control trials commonly include baseline infarct volume with or without penumbra evaluation. Although the collateral status has been studied and is known to modify imaging results and clinical course, it has not been commonly used for trials. Many post hoc studies, however, revealed that collateral status can help predict infarct growth, recanalization success, decreased hemorrhagic transformation after EVT, and extension of the therapeutic time window for revascularization. Here, we systematically review the recent literature and summarized the outcomes of EVT according to the collateral status of patients with acute ischemic stroke caused by large vessel occlusion. The studies reviewed indicate that pretreatment collateral circulation is associated with both clinical and imaging outcomes after EVT in patients with acute ischemic stroke due to large vessel occlusion although most patients were already selected by other imaging or clinical criteria. However, treatment decisions using information on patients' collateral status have not progressed in clinical practice. Further randomized trials are needed to evaluate the risks and benefits of EVT in consideration of collateral status.
血管内治疗 (EVT) 使用新型机械血栓切除术装置已成为大血管闭塞引起的急性缺血性脑卒中患者的金标准。随机对照试验的选择标准通常包括基线梗死体积和/或半影评估。尽管侧支循环状态已被研究并已知会影响影像学结果和临床病程，但它并未被广泛用于试验。然而，许多事后研究表明，侧支循环状态可以帮助预测梗死进展、再通成功率、EVT 后出血性转化减少以及血管再通治疗时间窗的延长。在这里，我们系统地回顾了最近的文献，并根据大血管闭塞性急性缺血性脑卒中患者的侧支循环状态总结了 EVT 的结果。尽管大多数患者已经通过其他影像学或临床标准进行了选择，但综述的研究表明，大血管闭塞性急性缺血性脑卒中患者的预处理侧支循环与 EVT 后的临床和影像学结果相关。然而，在临床实践中，并未根据患者的侧支循环状态信息来做出治疗决策。需要进一步的随机试验来评估考虑侧支循环状态的 EVT 的风险和益处。
