Background and purpose

Clinical outcome after mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke is influenced by the intracerebral collateral status. We tested the hypothesis that patients with preexisting ipsilateral extracranial carotid artery stenosis (CAS) would have a better collateral status compared to non-CAS patients. Additionally, we evaluated MT-related adverse events and outcome for both groups.

Methods

Over a 7-year period, we identified all consecutive anterior circulation MT patients (excluding extracranial carotid artery occlusion and dissection). Patients were grouped into those with CAS ≥ 50% according to the NASCET criteria and those without significant carotid stenosis (non-CAS). Collateral status was rated on pre-treatment CT- or MR-angiography according to the Tan Score. Furthermore, we assessed postinterventional infarct size, adverse events and functional outcome at 90 days.

Results

We studied 281 LVO stroke patients, comprising 46 (16.4%) with underlying CAS ≥ 50%. Compared to non-CAS stroke patients (n = 235), patients with CAS-related stroke more often had favorable collaterals (76.1% vs. 46.0%). Recanalization rates were comparable between both groups. LVO stroke patients with underlying CAS more frequently had adverse events after MT (19.6% vs. 6.4%). Preexisting CAS was an independent predictor for favorable collateral status in multivariable models (Odds ratio: 3.3, p = 0.002), but post-interventional infarct size and functional 90-day outcome were not different between CAS and non-CAS patients.

Conclusions

Preexisting CAS ≥ 50% was associated with better collateral status in LVO stroke patients. However, functional 90-day outcome was independent from CAS, which could be related to a higher rate of adverse events.

中文翻译：

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前循环大血管闭塞的卒中病因与侧支状态之间的关系。

背景和目的

机械性血栓切除术（MT）大血管闭塞（LVO）中风后的临床结局受脑侧支配状态的影响。我们检验了以下假设：与非CAS患者相比，先前存在同侧颅外颈动脉狭窄（CAS）的患者具有更好的侧支状态。此外，我们评估了两组的MT相关不良事件和预后。

方法

在7年的时间里，我们确定了所有连续的前循环MT患者（不包括颅外颈动脉阻塞和解剖）。根据NASCET标准，将患者分为CAS≥50％的患者和没有明显颈动脉狭窄的患者（非CAS）。根据Tan评分，在治疗前的CT或MR血管造影术中评估侧支状态。此外，我们评估了90天时的介入后梗死面积，不良事件和功能结局。

结果

我们研究了281例LVO中风患者，其中46例（16.4％）的潜在CAS≥50％。与非CAS中风患者（n  = 235）相比，CAS相关中风患者更常具有有利的侧支（76.1％vs. 46.0％）。两组的再通率相当。具有潜在CAS的LVO脑卒中患者在MT后发生不良事件的比例更高（分别为19.6％和6.4％）。在多变量模型中，既有CAS是辅助因素是否有利的独立预测因素（几率：3.3，p  = 0.002），但CAS和非CAS患者的介入后梗死面积和90天功能结局无差异。

结论

LVO脑卒中患者先前存在CAS≥50％与更好的侧支状态相关。然而，90天的功能性结局独立于CAS，这可能与不良事件发生率更高有关。