Pretreatment Collateral Status Predicts Malignant Stroke Evolution in Patients Undergoing Endovascular Thrombectomy
Journal of Neurosonology and Neuroimaging
Early detection and management of malignant middle cerebral artery infarct (MMI) is clinically crucial, and many studies have investigated the predictors of MMI evolution. However, to date, little is known about MMI predictors in patients undergoing endovascular thrombectomy (ET). Therefore, this study attempts to investigate MMI predictors in these patients using a single center retrospective data. Methods: Ninety-three patients treated with ET for anterior circulation stroke were analyzed.
... e were analyzed. From pretreatment computed tomographic angiography (CTA), the collateral score was rated from 0 to 3 (0, 0% filling of the occluded territory; 1, >0% and ≤50% filling; 2, >50% and <100% filling; 3, 100% filling). The parenchymal hemorrhage and the size of the infarct were determined by gradient echo and diffusion-weighted magnetic resonance imaging performed 24 hours after the ET. Patients with and without MMI were compared with regard to demographic, clinical and radiological data. Using a multivariate logistic regression model, the independent predictors of MMI were confirmed. Results: Nineteen patients (20.4%) developed MMI. There were no signif icant differences between patients with and without MMI with regard to the rate of vascular risk factors and recanalization failure. Taken together, poor collateral circulation (collateral score 0 or 1), an infarct size >2/3 middle cerebral artery territory, and type 2 parenchymal hemorrhage formed the significant independent predictor of MMI. Conclusion: The collateral status based on pretreatment CTA independently predicts MMI evolution, and can, therefore, help early detection and management of MMI in patients undergoing ET.