Distinct intraarterial Clot Localizations affect Tissue-Level Collaterals and Venous Outflow Profiles. European journal of neurology Faizy, T. D., Kabiri, R., Christensen, S., Mlynash, M., Kuraitis, G., Broocks, G., Flottmann, F., Meyer, L., Leischner, H., Lansberg, M. G., Albers, G. W., Marks, M. P., Fiehler, J., Wintermark, M., Heit, J. J. 2021


BACKGROUND AND AIM: Arterial clot localization affects collateral flow to ischemic brain in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). We determined the association between vessel occlusion locations, tissue-level collaterals (TLC) and venous outflow (VO) profiles and their impact on good functional outcomes.MATERIALS AND METHODS: Multicenter retrospective cohort study of consecutive AIS-LVO patients who underwent thrombectomy triage. Baseline CT angiography (CTA) was used to localize vessel occlusion, which was dichotomized into proximal vessel occlusion (PVO; internal carotid artery and proximal M1) and distal vessel occlusion (DVO; distal M1 and M2) and to assess collateral score. TLC were assessed on CT perfusion data using the Hypoperfusion Intensity Ratio (HIR). VO was determined on baseline CTA by the cortical vein opacification score. Primary outcomes were favorable VO and TLC, secondary outcome the Modified Ranking Scale (mRS) after 90 days.RESULTS: 649 patients met inclusion criteria. 376 patients (58%) had a PVO and 273 patients (42%) had a DVO. Multivariable ordinal logistic regression showed that DVO predicted favorable TLC (OR=1.77 [95% CI: 1.24-2.52]; p=0.002) and favorable VO (OR=7.2 [95% CI: 5.2-11.9]; p<0.001). DVO (OR=3.4 [95% CI: 2.1-5.6]; p<0.001), favorable VO (OR=6.4 [95% CI: 3.8-10.6]; p<0.001) and favorable TLC (OR=3.2 [95% CI: 2-5.3]; p<0.001), but not CTA collaterals (OR=1.07 [95% CI: 0.60-1.91]; p=0.813), were predictors of good functional outcome.CONCLUSION: DVO in AIS-LVO patients correlate with favorable TLC and VO profiles, which are associated with good functional outcome.

View details for DOI 10.1111/ene.15079

View details for PubMedID 34424584