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Extending the Time Window for Endovascular Procedures According to Collateral Pial Circulation

2011; Lippincott Williams & Wilkins; Volume: 42; Issue: 12 Linguagem: Inglês

10.1161/strokeaha.111.623827

1524-4628

Marc Ribó, Alan Flores, Marta Rubiera, Jorge Pagola, João Sargento‐Freitas, David Rodríguez‐Luna, Pilar Coscojuela, Olga Maisterra, Socorro Piñeiro, Francisco J. Romero, José Álvarez‐Sabín, Carlos A. Molina,

Intracranial Aneurysms: Treatment and Complications

Good collateral pial circulation (CPC) predicts a favorable outcome in patients undergoing intra-arterial procedures. We aimed to determine if CPC status may be used to decide about pursuing recanalization efforts.Pial collateral score (0-5) was determined on initial angiogram. We considered good CPC when pial collateral score 4-point decline in admission-discharge National Institutes of Health Stroke Scale.We studied CPC in 61 patients (31 middle cerebral artery, 30 internal carotid artery). Good CPC patients (n=21 [34%]) had lower discharge National Institutes of Health Stroke Scale score (7 versus 21; P=0.02) and smaller infarcts (56 mL versus 238 mL; P<0.001). In poor CPC patients, a receiver operating characteristic curve defined a TTI cutoff point<300 minutes (sensitivity 67%, specificity 75%) that better predicted clinical improvement (TTI 300: 25%; P=0.05). For good CPC patients, no temporal cutoff point could be defined. Although clinical improvement was similar for patients recanalizing within 300 minutes (poor CPC: 60% versus good CPC: 85.7%; P=0.35), the likelihood of clinical improvement was 3-fold higher after 300 minutes only in good CPC patients (23.1% versus 90.1%; P=0.01). Similarly, infarct volume was reduced 7-fold in good as compared with poor CPC patients only when TTI>300 minutes (TTI 300: poor CPC: 217 mL versus good CPC: 33 mL; P<0.01). After adjusting for age and baseline National Institutes of Health Stroke Scale score, TTI<300 emerged as an independent predictor of clinical improvement in poor CPC patients (OR, 6.6; 95% CI, 1.01-44.3; P=0.05) but not in good CPC patients. In a logistic regression, good CPC independently predicted clinical improvement after adjusting for TTI, admission National Institutes of Health Stroke Scale score, and age (OR, 12.5; 95% CI, 1.6-74.8; P=0.016).Good CPC predicts better clinical response to intra-arterial treatment beyond 5 hours from onset. In patients with stroke receiving endovascular treatment, identification of good CPC may help physicians when considering pursuing recanalization efforts in late time windows.