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Collateral Status and Outcomes after Thrombectomy

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Abstract

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.

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Abbreviations

DAWN:

Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake-up and late presenting strokes undergoing neurointervention with Trevo

DEFUSE:

Diffusion and perfusion imaging evaluation for understanding stroke evolution study

ESCAPE:

Endovascular treatment for small core and anterior circulation proximal occlusion with emphasis on minimizing CT to recanalization times

EXTEND-IA:

Extending the time for thrombolysis in emergency neurological deficits–intra-arterial

FLAIR:

Fluid attenuation inversion recovery

HERMES:

Highly effective reperfusion evaluated in multiple endovascular stroke

IMS III:

Interventional management of stroke III

MR CLEAN:

Multicenter randomized clinical trial of endothelial treatment for acute ischemic stroke in the Netherlands

MR RESCUE:

Mechanical retrieval and recanalization of stroke clots using embolectomy

REVASCAT:

Randomized trial of revascularization with solitaire FR device vs. best medical therapy in the treatment of acute stroke due to anterior circulation large vessel occlusion presenting within 8 h of symptom onset

SWIFT:

Solitaire with the intention for thrombectomy

SWIFT PRIME:

Solitaire with the intention for thrombectomy as primary endovascular treatment for acute ischemic stroke

SYNTHESIS:

Intra-arterial vs. systemic thrombolysis for acute ischemic stroke

TREVO 2:

Thrombectomy revascularization of large vessel occlusions in acute ischemic stroke 2

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  1. Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea

    Jin Soo Lee

  2. Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Oh Young Bang

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Lee, J.S., Bang, O.Y. Collateral Status and Outcomes after Thrombectomy. Transl. Stroke Res. 14, 22–37 (2023). https://doi.org/10.1007/s12975-022-01046-z

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