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Presence of the Posterior Communicating Artery Contributes to the Clinical Outcome After Endovascular Treatment of Patients with MCA Occlusions

  • Clinical Investigation
  • Stroke/Neurointerventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

In patients with acute occlusions of the middle cerebral artery, the collaterals play an important role in infarct growth and potentially on clinical outcome. As the primary collateral pathway, the posterior cerebral artery with the posterior communicating artery (PComA) is important. We analyzed the influence of the presence of an ipsilateral PComA on infarct growth and clinical outcome.

Methods

We included 101 patients with M1 occlusions and subsequent endovascular treatment and differentiated patients without an ipsilateral PComA from those with an ipsilateral PComA.

Results

There was no difference in the rate of successful recanalizations and procedural parameters between both groups. Of the patients with an existing PComA, 51% showed an excellent clinical outcome (90d mRS < 2), but only 28% of the patients without PComA had an excellent clinical outcome (p = 0.02). The presence of an ipsilateral PComA was independently associated with the rate of excellent clinical outcome (aOR 3.9, 95% CI 1.2–9.8; p = 0.021) and lower infarct volume (38 ± 8 cm3 vs. 78 ± 13 cm3, p = 0.032).

Conclusion

The presence of an ipsilateral PComA is a predictor for excellent clinical outcome independently from the technical success of mechanical recanalization. This finding provides insights into the changes of circulation in patients suffering from an acute stroke and underlines the importance of collateralization.

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Abbreviations

ACA:

Anterior cerebral artery

AComA:

Anterior communicating artery

aOR:

Adjusted Odds Ratio

ASPECTS:

Alberta Stroke Program Early CT Score

CI:

Confidence interval

CTA:

Computed tomography angiography

CTP:

Computed tomography perfusion

DSA:

Digital subtraction angiography

DWI:

Diffusion-weighted imaging

ICA:

Internal carotid artery

LVO:

Large vessel occlusion

MCA:

Middle cerebral artery

mRS:

Modified Rankin Scale

MT:

Mechanical thrombectomy

mTICI:

Modified Thrombolysis in Cerebral Infarction

NIHSS:

National Institute of Health Stroke Scale

PComA:

Posterior communicating artery

tPA:

Tissue plasminogen activator

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany

    Benjamin Friedrich, Tobias Boeckh-Behrens, Johanna Fischer, Manuel Lehm, Maria Bernd, Sebastian Mönch, Claus Zimmer & Christian Maegerlein

  2. Arnold Sommerfeld Center for Theoretical Physics, Department of Physics, LMU Munich, Munich, Germany

    Felix Kempf

  3. Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany

    Silke Wunderlich

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  1. Benjamin Friedrich
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Correspondence to Christian Maegerlein.

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Friedrich, B., Kempf, F., Boeckh-Behrens, T. et al. Presence of the Posterior Communicating Artery Contributes to the Clinical Outcome After Endovascular Treatment of Patients with MCA Occlusions. Cardiovasc Intervent Radiol 41, 1917–1924 (2018). https://doi.org/10.1007/s00270-018-2029-6

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