Presence of the Posterior Communicating Artery Contributes to the Clinical Outcome After Endovascular Treatment of Patients with MCA Occlusions
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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.
We included 101 patients with M1 occlusions and subsequent endovascular treatment and differentiated patients without an ipsilateral PComA from those with an ipsilateral PComA.
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).
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.
KeywordsStroke Anatomy Collateral circulation Endovascular treatment Outcome
Anterior cerebral artery
Anterior communicating artery
Adjusted Odds Ratio
Alberta Stroke Program Early CT Score
Computed tomography angiography
Computed tomography perfusion
Digital subtraction angiography
Internal carotid artery
Large vessel occlusion
Middle cerebral artery
Modified Rankin Scale
Modified Thrombolysis in Cerebral Infarction
National Institute of Health Stroke Scale
Posterior communicating artery
Tissue plasminogen activator
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
For this type of study, informed consent is not required.
Consent for Publication
For this type of study, consent for publication is not required.
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