Impact of collaterals on successful revascularization in Solitaire FR with the intention for thrombectomy

DS Liebeskind, R Jahan, RG Nogueira, OO Zaidat… - Stroke, 2014 - Am Heart Assoc
DS Liebeskind, R Jahan, RG Nogueira, OO Zaidat, JL Saver
Stroke, 2014Am Heart Assoc
Background and Purpose—Collaterals at angiography before endovascular therapy were
analyzed to ascertain the effect on a novel end point of successful revascularization without
symptomatic hemorrhage in the Solitaire FR With the Intention for Thrombectomy (SWIFT)
study. Methods—Collateral grade (American Society of Interventional and Therapeutic
Neuroradiology/Society of Interventional Radiology) on baseline angiography was
independently assessed, blind to other data, with statistical analyses delineating the …
Background and Purpose
Collaterals at angiography before endovascular therapy were analyzed to ascertain the effect on a novel end point of successful revascularization without symptomatic hemorrhage in the Solitaire FR With the Intention for Thrombectomy (SWIFT) study.
Methods
Collateral grade (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology) on baseline angiography was independently assessed, blind to other data, with statistical analyses delineating the relationship with clinical, laboratory, and imaging parameters.
Results
Angiographic data on collaterals were available in 119 of 144 subjects (mean age, 67±12 years; 52% woman; median National Institutes of Health Stroke Scale, 18 [range, 8–28]). Worse collaterals were noted in subjects with elevated baseline blood glucose (P=0.013) and those with elevated baseline systolic blood pressure (P=0.039). Multivariate predictors of partial or worse collaterals included absence of prior hypertension (odds ratio, 4.049, P=0.012), smoking history (odds ratio, 3.822; P=0.013), and higher blood glucose (odds ratio, 1.017; P=0.022). Collaterals were strongly related to Alberta Stroke Program Early CT Score (ASPECTS) at baseline (0–1: median 8 [3–10]; 2–9 [5–10]; 3–9 [7–10]; 4–9 [8–10]; P<0.001) and 24 hours (0–1: median 1 [0–5]; 2–6 [0–10]; 3–8 [0–10]; 4–8 [4–8]; P<0.001). Better collaterals were linked with Thrombolysis in Cerebral Infarction 2b/3 reperfusion (P=0.019), better median National Institutes of Health Stroke Scale at day 7/discharge (P<0.001), and better day 90 modified Rankin Scale (P<0.001). Better collateral grade was associated with successful revascularization without symptomatic hemorrhage, mean 2.3 (95% confidence interval, 2.1–2.5) versus 1.9 (95% confidence interval, 1.7–2.2), P=0.021.
Conclusions
Better collaterals were associated with lower glucose, lower blood pressure, smaller baseline infarcts in SWIFT, and greater likelihood of successful revascularization without hemorrhage and good clinical outcomes.
Clinical Trial Registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01054560.
Am Heart Assoc