Background and purpose The impact of the cerebral collateral circulation on lesion progression and clinical outcome in ischaemic stroke is well established. Moreover, collateral status modifies the effect of endovascular treatment and was therefore used to select patients for therapy in prior trials. The purpose of this study was to quantify the effect of vessel recanalisation on lesion pathophysiology and clinical outcome in patients with a poor collateral profile. Materials and methods 129 patients who had an ischaemic stroke with large vessel occlusion in the anterior circulation and a collateral score (CS) of 0–2 were included. Collateral profile was defined using an established 5-point scoring system in CT angiography. Lesion progression was determined using quantitative lesion water uptake measurements on admission and follow-up CT (FCT), and clinical outcome was assessed using modified Rankin Scale (mRS) scores after 90 days. Results Oedema formation in FCT was significantly lower in patients with vessel recanalisation compared with patients with persistent vessel occlusion (mean 19.5%, 95% CI: 17% to 22% vs mean 27%, 95% CI: 25% to 29%; p<0.0001). In a multivariable linear regression analysis, vessel recanalisation was significantly associated with oedema formation in FCT (ß=−7.31, SD=0.015, p<0.0001), adjusted for CS, age and Alberta Stroke Program Early CT Score (ASPECTS). Functional outcome was significantly better in patients following successful recanalisation (mRS at day 90: 4.5, IQR: 2–6 vs 5, IQR: 5–6, p<0.001). Conclusion Although poor collaterals are known to be associated with poor outcome, endovascular recanalisation was still associated with significant oedema reduction and comparably better outcome in this patient group. Patients with poor collaterals should not generally be excluded from thrombectomy. Data that support the findings of this study are available upon reasonable request.

中文翻译：

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血栓切除术对侧支循环不良患者水肿进展和临床结果的影响

背景和目的 脑侧支循环对缺血性卒中病变进展和临床结果的影响已得到充分证实。此外，侧支状态改变了血管内治疗的效果，因此在之前的试验中被用于选择接受治疗的患者。本研究的目的是量化血管再通对侧支不良患者病变病理生理学和临床结果的影响。材料和方法 129 例前循环大血管闭塞缺血性卒中患者，侧支循环评分（CS）为 0-2。侧支轮廓是使用 CT 血管造影中已建立的 5 点评分系统定义的。使用入院时和随访 CT (FCT) 时的定量病变水吸收测量来确定病变进展，90 天后使用改良 Rankin 量表 (mRS) 评分评估临床结果。结果 与持续性血管闭塞患者相比，血管再通患者的 FCT 水肿形成显着降低（平均 19.5%，95% CI：17% 至 22% vs 平均 27%，95% CI：25% 至 29%；p <0.0001)。在多变量线性回归分析中，血管再通与 FCT 中的水肿形成显着相关（ß=-7.31，SD=0.015，p<0.0001），根据 CS、年龄和阿尔伯塔中风计划早期 CT 评分（ASPECTS）进行了调整。成功再通后患者的功能结果明显更好（第 90 天的 mRS：4.5，IQR：2-6 vs 5，IQR：5-6，p<0.001）。结论 虽然已知不良侧支循环与不良预后相关，但 在该患者组中，血管内再通仍与显着的水肿减轻和更好的结果相关。侧支循环不良的患者通常不应被排除在血栓切除术之外。可根据合理要求提供支持本研究结果的数据。