Clinical and Imaging Determinants of Collateral Status in Patients With Acute Ischemic Stroke in MR CLEAN Trial and Registry

Eveline J. A. Wiegers*, Maxim J. H. L. Mulder, Ivo G. H. Jansen, Esmee Venema, Kars C. J. Compagne, Olvert A. Berkhemer, Bart J. Emmer, Henk A. Marquering, Adriaan C. G. M. van Es, Marieke E. Sprengers, Wim H. van Zwam, Robert J. van Oostenbrugge, Yvo B. W. E. M. Roos, Charles B. L. M. Majoie, Bob Roozenbeek, Hester F. Lingsma, Diederik W. J. Dippel, Aad van der Lugt

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background and Purpose-

Collateral circulation status at baseline is associated with functional outcome after ischemic stroke and effect of endovascular treatment. We aimed to identify clinical and imaging determinants that are associated with collateral grade on baseline computed tomography angiography in patients with acute ischemic stroke due to an anterior circulation large vessel occlusion.

Methods-

Patients included in the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; n=500) and MR CLEAN Registry (n=1488) were studied. Collateral status on baseline computed tomography angiography was scored from 0 (absent) to 3 (good). Multivariable ordinal logistic regression analyses were used to test the association of selected determinants with collateral status.

Results-

In total, 1988 patients were analyzed. Distribution of the collateral status was as follows: absent (7%, n=123), poor (32%, n=596), moderate (39%, n=735), and good (23%, n=422). Associations for a poor collateral status in a multivariable model existed for age (adjusted common odds ratio, 0.92 per 10 years [95% CI, 0.886-0.98]), male (adjusted common odds ratio, 0.64 [95% CI, 0.53-0.76]), blood glucose level (adjusted common odds ratio, 0.97 [95% CI, 0.95-1.00]), and occlusion of the intracranial segment of the internal carotid artery with occlusion of the terminus (adjusted common odds ratio 0.50 [95% CI, 0.41-0.61]). In contrast to previous studies, we did not find an association between cardiovascular risk factors and collateral status.

Conclusions-

Older age, male sex, high glucose levels, and intracranial internal carotid artery with occlusion of the terminus occlusions are associated with poor computed tomography angiography collateral grades in patients with acute ischemic stroke eligible for endovascular treatment.

Original languageEnglish
Pages (from-to)1493-1502
Number of pages10
JournalStroke
Volume51
Issue number5
DOIs
Publication statusPublished - May 2020

Keywords

  • collateral circulation
  • computed tomography angiography
  • odds ratio
  • stroke
  • thrombosis
  • CT ANGIOGRAPHY
  • SEX-DIFFERENCES
  • LEPTOMENINGEAL COLLATERALS
  • INTRAARTERIAL TREATMENT
  • CIRCULATION
  • VESSELS
  • HYPERGLYCEMIA
  • PREDICTOR
  • SEVERITY
  • OUTCOMES

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