Collateral Blood Flow Determines Outcomes in Patients with Acute Ischemic Stroke Undergoing Endovascular Therapy

A new research finding established that the ‘Collateral Blood Flow’ is an important determinant of outcome in patients with acute ischemic stroke who are undergoing endovascular therapy.

David Liebeskind and his team of research scientists at the University of California at Los Angeles Stroke Center, United States carried out an intensive research study that concluded with such findings. These findings with all relevant details and analyses have also been published in the “Journal of Neurology, Neurosurgery, and Psychiatry” recently.

“Considering that ‘recanalization’ is often achieved in only a fraction of cases undergoing endovascular therapy, further research on collateral circulation and related therapeutic approaches is warranted,” says David Liebeskind the lead researcher from the “University of California at Los Angeles Stroke Center, USA”.

David Liebeskind’s team of researchers examined collateral blood flow in 44 stroke patients who underwent angiography and cerebral imaging prior to attempted recanalization with thrombolytic agents or mechanical thrombectomy.

Researchers subsequently found that the ‘Collateral Blood Flow’ was graded from 0 , which is a ‘no visible collateral blood flow’ position to 4 , which is the complete’ rapid collateral blood flow’ position. Collateral flow was poor in seven patients with a grade of 0-1, intermediate in 20 with a grade of 2-3, and good in 17 with a grade of 4.

The research study revealed that the size of mismatch between perfusion- and diffusion-weighted imaging volumes did not relate to collateral grade, but, within the mismatch area, patients with good collateral flow had less severe hypo perfusion.

Findings of this research study show that the presence of good collaterals also appeared to limit infarct growth, with collateral grade inversely related to infarct growth among 32 patients who underwent repeat imaging at 3-5 days after treatment. Average infarct growth was 21.8 ml among patients with good collaterals versus 118.9 ml among those with poor collateral flow.

David Liebeskind’s research team observed that the ‘Collateral Grade’ was independently associated with infarct growth after accounting for confounders. Mismatch volume correlated positively with infarct growth, but this association disappeared after adjusting for confounders including collateral grade.

Furthermore, the study also established that there was a trend toward patients with better collaterals being more likely to achieve recanalization, at 0%, 25%, and 41% of patients with poor, intermediate, and good collaterals, respectively.

“Despite these influential aspects of collateral flow, collaterals at angiography are often only considered as an interesting curiosity and are not typically used for decision-making in endovascular management,” the researchers write in the “Journal of Neurology, Neurosurgery, and Psychiatry”.

David Liebeskind, the lead researcher of this study concluded with the remark,”Therapeutic strategies enhancing collaterals may ultimately be as important as recanalization“.

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