Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion

Valeria Guglielmi, Natalie E. LeCouffe, Sanne M. Zinkstok, Kars C. J. Compagne, Reyhan Eker, Kilian M. Treurniet, Manon L. Tolhuisen, H. Bart van der Worp, Ivo G. H. Jansen, Robert J. van Oostenbrugge, Henk A. Marquering, Diederik W. J. Dippel, Bart J. Emmer, Charles B. L. M. Majoie, Yvo B. W. E. M. Roos, Jonathan M. Coutinho*, Aad van der Lugt, Wim H. van Zwam, Jelis Boiten, Jan A. VosMaxim J. H. L. Mulder, Robert-Jan B. Goldhoorn, Manon Kappelhof, Wouter J. Schonewille, Marieke J. H. Wermer, Marianne A. A. van Walderveen, Julie Staals, Jeannette Hofmeijer, Jasper M. Martens, Geert J. Lycklama A. Nijeholt, Bob Roozenbeek, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Rob H. Lo, Ewoud J. van Dijk, Hieronymus D. Boogaarts, Paul L. M. de Kort, Jo P. Peluso, Jan S. P. van den Berg, Boudewijn A. A. M. van Hasselt, Leo A. M. Aerden, Rene J. Dallinga, Maarten Uyttenboogaart, Omid Eshghi, Tobien H. C. M. L. Schreuder, Roel J. J. Heijboer, Koos Keizer, Alida A. Postma, Wouter Hinsenveld, P. F. C. Groot, MR CLEAN Registry Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background and Purpose-Due to chronic hypoperfusion, cervical atherosclerosis may promote cerebral collateral circulation. We hypothesized that patients with ischemic stroke due to cervical carotid atherosclerosis have a more extensive collateral circulation and better outcomes than patients with cardioembolism. We tested this hypothesis in a population of patients who underwent endovascular treatment for large vessel occlusion.

Methods-From the MR-CLEAN Registry (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), we selected consecutive adult endovascular treatment patients (March 2014 to June 2016) with acute ischemic stroke due to anterior circulation large vessel occlusion and compared patients with cervical carotid artery stenosis >50% to those with cardioembolic etiology. The primary outcome was collateral score, graded on a 4-point scale. Secondary outcomes included the modified Rankin Scale (mRS) score and mortality at 90 days. We performed multivariable regression analyses and adjusted for potential confounders.

Results-Of 1627 patients in the Registry, 190 patients with cervical carotid atherosclerosis and 476 with cardioembolism were included. Patients with cervical carotid atherosclerosis were younger (median 69 versus 76 years, P

Conclusions-Patients with stroke due to cervical carotid atherosclerosis had a more extensive cerebral collateral circulation and a slightly better median mRS at 90 days than patients with cardioembolic stroke.

Original languageEnglish
Pages (from-to)3360-3368
Number of pages9
Issue number12
Publication statusPublished - Dec 2019


  • atherothrombotic stroke
  • cardiac emboli
  • collateral circulation
  • endovascular treatment
  • ischemic stroke

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