Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial.
Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial.
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DOI：
10.1161/strokeaha.113.004072
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发表时间：
2014-03
期刊：
影响因子：
8.3
通讯作者：
IMS III Investigators
中科院分区：
文献类型：
--
作者：
Liebeskind DS;Tomsick TA;Foster LD;Yeatts SD;Carrozzella J;Demchuk AM;Jovin TG;Khatri P;von Kummer R;Sugg RM;Zaidat OO;Hussain SI;Goyal M;Menon BK;Al Ali F;Yan B;Palesch YY;Broderick JP;IMS III Investigators
Endovascular strategies provide unique opportunity to correlate angiographic measures of collateral circulation at the time of endovascular therapy. We conducted systematic analyses of collaterals at conventional angiography on recanalization, reperfusion and the clinical outcomes in the endovascular treatment arm of the Interventional Management of Stroke (IMS) III Trial. Prospective evaluation of angiographic collaterals was conducted via central review of subjects treated with endovascular therapy in IMS III (n=331). Collateral grade prior to endovascular therapy was assessed with the ASITN/SIR scale, blinded to all other data. Statistical analyses investigated the association between collaterals with baseline clinical variables, angiographic measures of recanalization, reperfusion and clinical outcomes. Adequate views of collateral circulation to the ischemic territory were available in 276/331 (83%) subjects. Collateral grade was strongly related to both recanalization of the occluded arterial segment (p=0.0016) and downstream reperfusion (p<0.0001). Multivariable analyses confirmed that robust angiographic collateral grade was a significant predictor of good clinical outcome (mRS≤2) at 90 days (p=0.0353), adjusted for age, history of diabetes, NIHSS strata, and ASPECTS. The relationship between collateral flow and clinical outcome may depend on the degree of reperfusion. More robust collateral grade was associated with better recanalization, reperfusion, and subsequent better clinical outcomes. These data, from the largest endovascular trial to date, suggest that collaterals are an important consideration in future trial design.
