Background: Collateral flow (CF) is an effective predictor of outcome in acute ischemic stroke (AIS) with potential to sustain the ischemic penumbra. However, the clinical prognostic value of CF in patients with AIS undergoing mechanical thrombectomy has not been clearly established. We evaluated the relationship of CF with clinical outcomes in patients with large artery anterior circulation AIS treated with mechanical thrombectomy.
Methods: Baseline collaterals of patients with AIS (n=135) undergoing mechanical thrombectomy were independently evaluated by CT angiography (CTA) and conventional angiography and dichotomized into poor and good CF. Multivariable analyses were performed to evaluate the predictive effect of CF on outcome and the effect of time to reperfusion on outcome based on adequacy of the collaterals.
Results: Evaluation of CF was consistent by both CTA and conventional angiography (p<0.0001). A higher rate of patients with good collaterals had good functional outcome at 3-month follow-up compared with those with poor collaterals (modified Rankin Scale (mRS) 0-2: 60% vs 10%, p=0.0001). Patients with poor collaterals had a significantly higher mortality rate (mRS 6: 45% vs 8%, p=0.0001). Multivariable analyses showed that CF was the strongest predictor of outcome. Time to reperfusion had a clear effect on favorable outcome (mRS ≤2) in patients with good collaterals; in patients with poor collaterals this effect was only seen when mRS ≤3 was considered an acceptable outcome.
Conclusions: CTA is a valid tool for assessing the ability of CF to predict clinical outcome in patients with AIS treated with mechanical thrombectomy. Limiting time to reperfusion is of definite value in patients with good collaterals and also to some extent in those with poor collaterals.
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http://dx.doi.org/10.1136/neurintsurg-2016-012628 | DOI Listing |
AJNR Am J Neuroradiol
January 2025
From the Department of Radiology, Medical Physics (MML, TJC), Department of Interventional Radiology (NS, GAC), Department of Surgery and Large Animal Studies (MAN), and the Department of Statistics (MG), University of Chicago, Chicago, IL, USA; Department of Anesthesiology (SPR), University of Illinois, Chicago, IL, USA; Department of Radiology (MSS), University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Radiology, Biomedical Engineering and Imaging Institute (Current affiliation MML), Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mount Carmel Health Systems (Current affiliation GAC), Columbus, OH, USA.
Background And Purpose: In acute ischemic stroke, the amount of "local" CBF distal to the occlusion, i.e. all blood flow within a region whether supplied antegrade or delayed and dispersed through the collateral network, may contain valuable information regarding infarct growth rate and treatment response.
View Article and Find Full Text PDFJ Stomatol Oral Maxillofac Surg
January 2025
Professor, Department of Oral, Dental and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University, Erzurum, 25240, Turkiye.
Objectives: This study aimed to evaluate with ultrasonography (US) the location of GPF, the course of the GPA, and to measure palatal fibromucosa thickness.
Materials And Methods: This in vivo experiment was conducted on a group of healthy, young Turkish subjects. Using the US, the localization of the GPF, its diameter and opening type, maximum flow velocity (Vmax) and collateral branches (CB) of the GPA, and the thickness of the palatine mucosa were evaluated.
Prz Gastroenterol
August 2023
Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Introduction: Portal hypertension is a common complication of liver cirrhosis. Varices are dilated collaterals that develop as a result of portal hypertension at the level of the porto-systemic connections and can cause a shift in the blood flow from high to low pressure. Common locations for porto-systemic shunts are the lower oesophagus and the gastric fundus.
View Article and Find Full Text PDFWorld J Pediatr Congenit Heart Surg
January 2025
Department of Pediatrics, Inova Health System, Falls Church, VA, USA.
Pulmonary atresia with ventricular septal defect (PA-VSD) is usually diagnosed by transthoracic or fetal echocardiography, with the prenatal diagnosis being feasible and accurate if fetal cardiology services are available. The limitations of transthoracic echocardiography (TTE) in the evaluation of PA-VSD include the complete evaluation of the pulmonary arteries and patent ductus arteriosus, quantitative evaluation of the right ventricle size and function, and delineation of associated cardiac anomalies such as coronary artery anomalies, anomalies of systemic or pulmonary venous return, and complex arch anomalies. Echocardiography also has limitations in evaluating hemodynamics such as flow volumes, shunts, and regurgitant fraction.
View Article and Find Full Text PDFWorld J Pediatr Congenit Heart Surg
January 2025
Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada.
The presentation of pulmonary vasculature in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCA) is highly variable-as is the number, size and position of the MAPCAs and their relationship with the native pulmonary artery system. The priority in the management of this disease should be attaining timely and complete unifocalization, as opposed to single-stage full repair in every case. The merit of early unifocalization is that it secures the pulmonary vascular bed by (a) avoiding loss of lung segments from progressive stenosis/atresia of MAPCA origins, (b) preventing lung injury from high pressure/flow in areas fed by large, unobstructed MAPCAs, and (c) restoring central continuity of the pulmonary vasculature.
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