Advertisement

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

  • Benjamin Friedrich
  • Felix Kempf
  • Tobias Boeckh-Behrens
  • Johanna Fischer
  • Manuel Lehm
  • Maria Bernd
  • Silke Wunderlich
  • Sebastian Mönch
  • Claus Zimmer
  • Christian Maegerlein
Clinical Investigation Stroke
  • 9 Downloads
Part of the following topical collections:
  1. Stroke

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.

Keywords

Stroke Anatomy Collateral circulation Endovascular treatment Outcome 

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

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed Consent

For this type of study, informed consent is not required.

Consent for Publication

For this type of study, consent for publication is not required.

Supplementary material

270_2018_2029_MOESM1_ESM.pdf (311 kb)
Supplementary material 1 (PDF 310 kb)

References

  1. 1.
    Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95.  https://doi.org/10.1056/NEJMoa1415061.CrossRefPubMedGoogle Scholar
  2. 2.
    Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.  https://doi.org/10.1056/NEJMoa1503780.CrossRefPubMedGoogle Scholar
  3. 3.
    Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.  https://doi.org/10.1056/NEJMoa1414905.CrossRefPubMedGoogle Scholar
  4. 4.
    Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20.  https://doi.org/10.1056/NEJMoa1411587.CrossRefPubMedGoogle Scholar
  5. 5.
    Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18.  https://doi.org/10.1056/NEJMoa1414792.CrossRefPubMedGoogle Scholar
  6. 6.
    Dargazanli C, Consoli A, Barral M, Labreuche J, Redjem H, Ciccio G, et al. Impact of modified TICI 3 versus modified TICI 2b reperfusion score to predict good outcome following endovascular therapy. AJNR Am J Neuroradiol. 2016.  https://doi.org/10.3174/ajnr.A4968.PubMedGoogle Scholar
  7. 7.
    Kaesmacher J, Maegerlein C, Zibold F, Wunderlich S, Zimmer C, Friedrich B. Improving mTICI2b reperfusion to mTICI2c/3 reperfusions: a retrospective observational study assessing technical feasibility, safety and clinical efficacy. Eur Radiol. 2017.  https://doi.org/10.1007/s00330-017-4928-3.PubMedGoogle Scholar
  8. 8.
    Kleine JF, Wunderlich S, Zimmer C, Kaesmacher J. Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy. J Neurointerv Surg. 2016.  https://doi.org/10.1136/neurintsurg-2015-012218.Google Scholar
  9. 9.
    Espinosa de Rueda M, Parrilla G, Manzano-Fernandez S, Garcia-Villalba B, Zamarro J, Hernandez-Fernandez F, et al. Combined multimodal computed tomography score correlates with futile recanalization after thrombectomy in patients with acute stroke. Stroke. 2015;46(9):2517–22.  https://doi.org/10.1161/STROKEAHA.114.008598.CrossRefPubMedGoogle Scholar
  10. 10.
    Hussein HM, Georgiadis AL, Vazquez G, Miley JT, Memon MZ, Mohammad YM, et al. Occurrence and predictors of futile recanalization following endovascular treatment among patients with acute ischemic stroke: a multicenter study. AJNR Am J Neuroradiol. 2010;31(3):454–8.  https://doi.org/10.3174/ajnr.A2006.CrossRefPubMedGoogle Scholar
  11. 11.
    Kawiorski MM, Martinez-Sanchez P, Garcia-Pastor A, Calleja P, Fuentes B, Sanz-Cuesta BE, et al. Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke. Neuroradiology. 2016;58(5):487–93.  https://doi.org/10.1007/s00234-016-1652-7.CrossRefPubMedGoogle Scholar
  12. 12.
    Prothmann S, Schwaiger BJ, Gersing AS, Reith W, Niederstadt T, Felber A, et al. Acute recanalization of thrombo-embolic ischemic stroke with pREset (ARTESp): the impact of occlusion time on clinical outcome of directly admitted and transferred patients. J Neurointerv Surg. 2016.  https://doi.org/10.1136/neurintsurg-2016-012556.PubMedCentralGoogle Scholar
  13. 13.
    Cheripelli BK, Huang X, McVerry F, Muir KW. What is the relationship among penumbra volume, collaterals, and time since onset in the first 6 h after acute ischemic stroke? Int J Stroke. 2016;11(3):338–46.  https://doi.org/10.1177/1747493015620807.CrossRefPubMedGoogle Scholar
  14. 14.
    Christoforidis GA, Vakil P, Ansari SA, Dehkordi FH, Carroll TJ. Impact of pial collaterals on infarct growth rate in experimental acute ischemic stroke. AJNR Am J Neuroradiol. 2017;38(2):270–5.  https://doi.org/10.3174/ajnr.A5003.CrossRefPubMedGoogle Scholar
  15. 15.
    Fanou EM, Knight J, Aviv RI, Hojjat SP, Symons SP, Zhang L, et al. Effect of collaterals on clinical presentation, baseline imaging, complications, and outcome in acute stroke. AJNR Am J Neuroradiol. 2015;36(12):2285–91.  https://doi.org/10.3174/ajnr.A4453.CrossRefPubMedGoogle Scholar
  16. 16.
    Liebeskind DS, Jahan R, Nogueira RG, Jovin TG, Lutsep HL, Saver JL, et al. Early arrival at the emergency department is associated with better collaterals, smaller established infarcts and better clinical outcomes with endovascular stroke therapy: SWIFT study. J Neurointerv Surg. 2016;8(6):553–8.  https://doi.org/10.1136/neurintsurg-2015-011758.CrossRefPubMedGoogle Scholar
  17. 17.
    Liebeskind DS, Jahan R, Nogueira RG, Zaidat OO, Saver JL, Investigators S. Impact of collaterals on successful revascularization in Solitaire FR with the intention for thrombectomy. Stroke. 2014;45(7):2036–40.  https://doi.org/10.1161/STROKEAHA.114.004781.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Tan BY, Wan-Yee K, Paliwal P, Gopinathan A, Nadarajah M, Ting E, et al. Good Intracranial collaterals trump poor ASPECTS (Alberta Stroke Program Early CT Score) for intravenous thrombolysis in anterior circulation acute ischemic stroke. Stroke. 2016;47(9):2292–8.  https://doi.org/10.1161/STROKEAHA.116.013879.CrossRefPubMedGoogle Scholar
  19. 19.
    Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2017.  https://doi.org/10.1056/NEJMoa1706442.Google Scholar
  20. 20.
    Jiang B, Churilov L, Kanesan L, Dowling R, Mitchell P, Dong Q, et al. Blood pressure may be associated with arterial collateralization in anterior circulation ischemic stroke before acute reperfusion therapy. J Stroke. 2017;19(2):222–8.  https://doi.org/10.5853/jos.2016.01739.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Chuang YM, Liu CY, Pan PJ, Lin CP. Posterior communicating artery hypoplasia as a risk factor for acute ischemic stroke in the absence of carotid artery occlusion. J Clin Neurosci. 2008;15(12):1376–81.  https://doi.org/10.1016/j.jocn.2008.02.002.CrossRefPubMedGoogle Scholar
  22. 22.
    Schomer DF, Marks MP, Steinberg GK, Johnstone IM, Boothroyd DB, Ross MR, et al. The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction. N Engl J Med. 1994;330(22):1565–70.  https://doi.org/10.1056/NEJM199406023302204.CrossRefPubMedGoogle Scholar
  23. 23.
    Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44(9):2650–63.  https://doi.org/10.1161/STROKEAHA.113.001972.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, et al. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage. 2006;31(3):1116–28.  https://doi.org/10.1016/j.neuroimage.2006.01.015.CrossRefPubMedGoogle Scholar
  25. 25.
    Dankbaar JW, Kerckhoffs KGP, Horsch AD, van der Schaaf IC, Kappelle LJ, Velthuis BK, et al. Internal carotid artery stenosis and collateral recruitment in stroke patients. Clin Neuroradiol. 2017.  https://doi.org/10.1007/s00062-017-0568-x.PubMedGoogle Scholar
  26. 26.
    Derdeyn CP. Hemodynamics and oxygen extraction in chronic large artery steno-occlusive disease: clinical applications for predicting stroke risk. J Cereb Blood Flow Metab. 2017.  https://doi.org/10.1177/0271678x17732884.Google Scholar
  27. 27.
    Liu X, Dornbos D 3rd, Pu Y, Leng X, Song L, Jia B, et al. Collateral circulation alters downstream hemodynamic stress caused by intracranial atherosclerotic stenosis. Neurol Res. 2017;39(6):498–503.  https://doi.org/10.1080/01616412.2017.1315483.CrossRefPubMedGoogle Scholar
  28. 28.
    Qiao Y, Anwar Z, Intrapiromkul J, Liu L, Zeiler SR, Leigh R, et al. Patterns and implications of intracranial arterial remodeling in stroke patients. Stroke. 2016;47(2):434–40.  https://doi.org/10.1161/STROKEAHA.115.009955.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Benjamin Friedrich
    • 1
  • Felix Kempf
    • 2
  • Tobias Boeckh-Behrens
    • 1
  • Johanna Fischer
    • 1
  • Manuel Lehm
    • 1
  • Maria Bernd
    • 1
  • Silke Wunderlich
    • 3
  • Sebastian Mönch
    • 1
  • Claus Zimmer
    • 1
  • Christian Maegerlein
    • 1
  1. 1.Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der IsarTechnical University MunichMunichGermany
  2. 2.Arnold Sommerfeld Center for Theoretical Physics, Department of PhysicsLMU MunichMunichGermany
  3. 3.Department of Neurology, Klinikum rechts der IsarTechnical University MunichMunichGermany

Personalised recommendations