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Very Late Leptomeningeal Collaterals—Potential New Way to Subdivide Modified Thrombolysis in Cerebral Ischemia (mTICI) 2B

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Abstract

Background

Studies have shown that the modified thrombolysis in cerebral ischemia (mTICI) 2B score is associated with better functional outcome; however, 50–99% reperfusion is a large range and there may be factors which can differentiate this further. The effects of very late leptomeningeal collaterals (VLLC) on mTICI-2B patients were studied.

Method

A prospectively collected registry of anterior circulation AIS patients treated with the EmboTrap revascularization device from 2013 to 2016 was evaluated. Imaging parameters and timings, including the mTICI score were verified by an external core laboratory blinded to the clinical data. The final angiogram was examined for the appearance of VLLC in predicting 3‑month outcomes including excellent functional outcomes, defined as modified Rankin scale (mRS) 0–1, bleeding risk and mortality.

Results

A total of 177 consecutive anterior circulation stroke patients were included in the analysis. Of these 94 (53.1%) achieved only mTICI-2B reperfusion, 16/94 (17.0%) patients achieved excellent functional outcomes at 3 months and 26 (27.7%) had hyperdensity on follow-up computed tomography (CT). On univariate analysis, the presence of VLLC was inversely associated with excellent functional outcomes at 3 months and positively associated with mortality in patients with mTICI-2B reperfusion. On multivariate analysis VLLC was inversely associated with excellent outcomes (odds ratio 0.075, 95% confidence interval 0.007–0.765, P = 0.029) but not associated with mortality.

Conclusion

The mTICI-2B grade may be further refined by secondary radiological markers. The VLLC sign is associated with the loss of excellent functional outcomes at 3 months. It is a simple sign to discriminate mTICI-2B into different grades but should be verified in larger populations from other centers.

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Contributor Statement

L. Yeo was involved in the concept, drafting the manuscript, data collection, image analysis, editing and final approval. A. Cervo was involved in the concept, drafting the manuscript, data collection, image analysis, editing and final approval. A. Gopinathan was involved in the editing and final approval. Y. Cunli was involved in the editing and final approval. A. Holmberg was involved in the concept and data collection. M. Söderman was involved in editing and final approval. S. Holmin was involved in editing and final approval. P. Bhogal was involved in the concept, editing and final approval. V. Gontu was involved in the concept, image analysis, editing and final approval. A. Mpotsaris was involved in data collection, image analysis, editing and final approval. T. Andersson was involved in the concept, drafting the manuscript, editing and final approval. S.A. Cornelissen was involved in the concept, drafting the manuscript, data collection, image analysis, editing and final approval.

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Authors and Affiliations

  1. Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden

    Leonard L. L. Yeo, Ake Holmberg, Michael Söderman, Staffan Holmin, Pervinder Bhogal, Vamsi Gontu & Tommy Andersson

  2. Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore

    Leonard L. L. Yeo

  3. Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy

    Amedeo Cervo

  4. Department of Diagnostic Imaging, National University Health System, Singapore, Singapore

    Anil Gopinathan & Yang Cunli

  5. Department of Neuroradiology, St. Bartholomew’s and the Royal London Hospital, London, UK

    Pervinder Bhogal

  6. Department of Neuroradiology, University hospital of Aachen, Aachen, Germany

    Anastasios Mpotsaris

  7. Department of Medical Imaging, AZ Groeninge, 8500, Kortrijk, Belgium

    Tommy Andersson

  8. University hospitals Leuven, Leuven, Belgium

    Sandra A. Cornelissen

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  1. Leonard L. L. Yeo
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Corresponding author

Correspondence to Leonard L. L. Yeo.

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Conflict of interest

T. Andersson is a consultant for Ablynx, Amnis Therapeutics, Medtronic, Cerenovus/J&J, Rapid Medical and Stryker. L. L. L. Yeo has received substantial grant funding from the National Medical Research Council (NMRC) Singapore and substantial support from the ministry of health (MOH) Singapore. M. Söderman is consultant for Medtronic, Cerenovus/J&J and Neurvana. P. Bhogal is consultant for Neurvana Medical and Phenox. A. Cervo, A. Gopinathan, Y. Cunli, A. Holmberg, S. Holmin, V. Gontu, A. Mpotsaris and S.A. Cornelissen declare that they have no competing interests.

Ethical standards

The study protocol was approved by the regional ethics committee in Stockholm (regionala etikprövningsnämnden i Stockholm) Diarienr:2016/1041-31/4.

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Yeo, L.L.L., Cervo, A., Gopinathan, A. et al. Very Late Leptomeningeal Collaterals—Potential New Way to Subdivide Modified Thrombolysis in Cerebral Ischemia (mTICI) 2B. Clin Neuroradiol 30, 77–83 (2020). https://doi.org/10.1007/s00062-018-0747-4

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