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. Vos; Maxim 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

doi:10.1161/STROKEAHA.119.026299

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 journal › Article › Academic › peer-review

Abstract

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 language	English
Pages (from-to)	3360-3368
Number of pages	9
Journal	Stroke
Volume	50
Issue number	12
DOIs	https://doi.org/10.1161/STROKEAHA.119.026299
Publication status	Published - Dec 2019

Keywords

atherothrombotic stroke
cardiac emboli
collateral circulation
endovascular treatment
ischemic stroke
ACUTE ISCHEMIC-STROKE
ATRIAL-FIBRILLATION
CT ANGIOGRAPHY
UNDETERMINED SOURCE
EMBOLIC STROKES
FEATURES
CLASSIFICATION
HYPOPERFUSION
THROMBECTOMY
ETIOLOGY

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Guglielmi, V., LeCouffe, N. E., Zinkstok, S. M., Compagne, K. C. J., Eker, R., Treurniet, K. M., Tolhuisen, M. L., van der Worp, H. B., Jansen, I. G. H., van Oostenbrugge, R. J., Marquering, H. A., Dippel, D. W. J., Emmer, B. J., Majoie, C. B. L. M., Roos, Y. B. W. E. M., Coutinho, J. M., van der Lugt, A., van Zwam, W. H., Boiten, J., ... MR CLEAN Registry Investigators (2019). Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion. Stroke, 50(12), 3360-3368. https://doi.org/10.1161/STROKEAHA.119.026299

@article{9600d8b4fc5b4b7ab29fbb74a2a14265,

title = "Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion",

abstract = "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, PConclusions-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.",

keywords = "atherothrombotic stroke, cardiac emboli, collateral circulation, endovascular treatment, ischemic stroke, ACUTE ISCHEMIC-STROKE, ATRIAL-FIBRILLATION, CT ANGIOGRAPHY, UNDETERMINED SOURCE, EMBOLIC STROKES, FEATURES, CLASSIFICATION, HYPOPERFUSION, THROMBECTOMY, ETIOLOGY",

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

note = "Funding Information: This study was funded and carried out by the Erasmus University Medical Centre, the Amsterdam UMC, location AMC, and the Maastricht University Medical Centre. The study was additionally funded by the Applied Scientific Institute for Neuromodulation (Toegepast Wetenschappelijk Instituut voor Neuromodulatie), which played no role in trial design and patient enrollment, nor in data collection, analysis, or writing of the article. Publisher Copyright: {\textcopyright} 2019 American Heart Association, Inc.",

year = "2019",

month = dec,

doi = "10.1161/STROKEAHA.119.026299",

language = "English",

volume = "50",

pages = "3360--3368",

journal = "Stroke",

issn = "0039-2499",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "12",

}

Guglielmi, V, LeCouffe, NE, Zinkstok, SM, Compagne, KCJ, Eker, R, Treurniet, KM, Tolhuisen, ML, van der Worp, HB, Jansen, IGH, van Oostenbrugge, RJ, Marquering, HA, Dippel, DWJ, Emmer, BJ, Majoie, CBLM, Roos, YBWEM, Coutinho, JM, van der Lugt, A, van Zwam, WH, Boiten, J, Vos, JA, Mulder, MJHL, Goldhoorn, R-JB, Kappelhof, M, Schonewille, WJ, Wermer, MJH, van Walderveen, MAA, Staals, J, Hofmeijer, J, Martens, JM, Nijeholt, GJLA, Roozenbeek, B, de Bruijn, SF, van Dijk, LC, Lo, RH, van Dijk, EJ, Boogaarts, HD, de Kort, PLM, Peluso, JP, van den Berg, JSP, van Hasselt, BAAM, Aerden, LAM, Dallinga, RJ, Uyttenboogaart, M, Eshghi, O, Schreuder, THCML, Heijboer, RJJ, Keizer, K, Postma, AA , Hinsenveld, W, Groot, PFC & MR CLEAN Registry Investigators 2019, 'Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion', Stroke, vol. 50, no. 12, pp. 3360-3368. https://doi.org/10.1161/STROKEAHA.119.026299

TY - JOUR

T1 - Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion

AU - Guglielmi, Valeria

AU - LeCouffe, Natalie E.

AU - Zinkstok, Sanne M.

AU - Compagne, Kars C. J.

AU - Eker, Reyhan

AU - Treurniet, Kilian M.

AU - Tolhuisen, Manon L.

AU - van der Worp, H. Bart

AU - Jansen, Ivo G. H.

AU - van Oostenbrugge, Robert J.

AU - Marquering, Henk A.

AU - Dippel, Diederik W. J.

AU - Emmer, Bart J.

AU - Majoie, Charles B. L. M.

AU - Roos, Yvo B. W. E. M.

AU - Coutinho, Jonathan M.

AU - van der Lugt, Aad

AU - van Zwam, Wim H.

AU - Boiten, Jelis

AU - Vos, Jan A.

AU - Mulder, Maxim J. H. L.

AU - Goldhoorn, Robert-Jan B.

AU - Kappelhof, Manon

AU - Schonewille, Wouter J.

AU - Wermer, Marieke J. H.

AU - van Walderveen, Marianne A. A.

AU - Staals, Julie

AU - Hofmeijer, Jeannette

AU - Martens, Jasper M.

AU - Nijeholt, Geert J. Lycklama A.

AU - Roozenbeek, Bob

AU - de Bruijn, Sebastiaan F.

AU - van Dijk, Lukas C.

AU - Lo, Rob H.

AU - van Dijk, Ewoud J.

AU - Boogaarts, Hieronymus D.

AU - de Kort, Paul L. M.

AU - Peluso, Jo P.

AU - van den Berg, Jan S. P.

AU - van Hasselt, Boudewijn A. A. M.

AU - Aerden, Leo A. M.

AU - Dallinga, Rene J.

AU - Uyttenboogaart, Maarten

AU - Eshghi, Omid

AU - Schreuder, Tobien H. C. M. L.

AU - Heijboer, Roel J. J.

AU - Keizer, Koos

AU - Postma, Alida A.

AU - Hinsenveld, Wouter

AU - Groot, P. F. C.

AU - MR CLEAN Registry Investigators

N1 - Funding Information: This study was funded and carried out by the Erasmus University Medical Centre, the Amsterdam UMC, location AMC, and the Maastricht University Medical Centre. The study was additionally funded by the Applied Scientific Institute for Neuromodulation (Toegepast Wetenschappelijk Instituut voor Neuromodulatie), which played no role in trial design and patient enrollment, nor in data collection, analysis, or writing of the article. Publisher Copyright: © 2019 American Heart Association, Inc.

PY - 2019/12

Y1 - 2019/12

N2 - 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, PConclusions-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.

AB - 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, PConclusions-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.

KW - atherothrombotic stroke

KW - cardiac emboli

KW - collateral circulation

KW - endovascular treatment

KW - ischemic stroke

KW - ACUTE ISCHEMIC-STROKE

KW - ATRIAL-FIBRILLATION

KW - CT ANGIOGRAPHY

KW - UNDETERMINED SOURCE

KW - EMBOLIC STROKES

KW - FEATURES

KW - CLASSIFICATION

KW - HYPOPERFUSION

KW - THROMBECTOMY

KW - ETIOLOGY

U2 - 10.1161/STROKEAHA.119.026299

DO - 10.1161/STROKEAHA.119.026299

M3 - Article

C2 - 31658903

SN - 0039-2499

VL - 50

SP - 3360

EP - 3368

JO - Stroke

JF - Stroke

IS - 12

ER -