Faculty Collaboration Database

Impact of collaterals on successful revascularization in Solitaire FR with the intention for thrombectomy. Stroke 2014 Jul;45(7):2036-40

Date

05/31/2014

Pubmed ID

24876081

Pubmed Central ID

PMC4157911

DOI

10.1161/STROKEAHA.114.004781

Scopus ID

2-s2.0-84903793602 (requires institutional sign-in at Scopus site)   170 Citations

Abstract

BACKGROUND AND PURPOSE: Collaterals at angiography before endovascular therapy were analyzed to ascertain the effect on a novel end point of successful revascularization without symptomatic hemorrhage in the Solitaire FR With the Intention for Thrombectomy (SWIFT) study.

METHODS: Collateral grade (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology) on baseline angiography was independently assessed, blind to other data, with statistical analyses delineating the relationship with clinical, laboratory, and imaging parameters.

RESULTS: Angiographic data on collaterals were available in 119 of 144 subjects (mean age, 67±12 years; 52% woman; median National Institutes of Health Stroke Scale, 18 [range, 8-28]). Worse collaterals were noted in subjects with elevated baseline blood glucose (P=0.013) and those with elevated baseline systolic blood pressure (P=0.039). Multivariate predictors of partial or worse collaterals included absence of prior hypertension (odds ratio, 4.049, P=0.012), smoking history (odds ratio, 3.822; P=0.013), and higher blood glucose (odds ratio, 1.017; P=0.022). Collaterals were strongly related to Alberta Stroke Program Early CT Score (ASPECTS) at baseline (0-1: median 8 [3-10]; 2-9 [5-10]; 3-9 [7-10]; 4-9 [8-10]; P<0.001) and 24 hours (0-1: median 1 [0-5]; 2-6 [0-10]; 3-8 [0-10]; 4-8 [4-8]; P<0.001). Better collaterals were linked with Thrombolysis in Cerebral Infarction 2b/3 reperfusion (P=0.019), better median National Institutes of Health Stroke Scale at day 7/discharge (P<0.001), and better day 90 modified Rankin Scale (P<0.001). Better collateral grade was associated with successful revascularization without symptomatic hemorrhage, mean 2.3 (95% confidence interval, 2.1-2.5) versus 1.9 (95% confidence interval, 1.7-2.2), P=0.021.

CONCLUSIONS: Better collaterals were associated with lower glucose, lower blood pressure, smaller baseline infarcts in SWIFT, and greater likelihood of successful revascularization without hemorrhage and good clinical outcomes.

CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01054560.

Author List

Liebeskind DS, Jahan R, Nogueira RG, Zaidat OO, Saver JL, SWIFT Investigators

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Blood Glucose
Blood Pressure
Cerebral Angiography
Cerebrovascular Circulation
Collateral Circulation
Female
Humans
Male
Middle Aged
Patient Outcome Assessment
Randomized Controlled Trials as Topic
Severity of Illness Index
Single-Blind Method
Stroke
Thrombectomy