The effect of cerebral collateral recycle on outcomes for patients with large ischemic infarct undergoing endovascular treatment.

Objective: Although several large clinical trials have shown that endovascular treatment (EVT) is beneficial for patients with large core infarction, their outcomes were still much worse than those with mild infarction. Therefore, given the cerebral collateral recycle (CCR) as an effective prognostic marker, this study explored the relationship between CCR and clinical outcomes in patients with large ischemic infarct.

Methods: We conducted a retrospective multicenter cohort study of patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Extensive baseline infarction was defined by ASPECTS ≤5 on admission computed tomography (CT). CCR was determined by quantifying pial arterial collaterals and venous outflow (VO) based on admission CT angiography. Patients were divided into two groups by CCR status. The primary outcomes was the favorable outcomes (90-day modified Rankin Scale score of ≤3).

Results: Among 860 AIS-LVO patients receiving EVT, 140 patients met the inclusion criteria. In multivariable binary logistic regression analysis, compared with the unfavorable CCR group, the favorable CCR group had a higher rate of favorable outcomes at 90 days (84.62 % vs 32.46 %, aOR 8.08, 95 % CI 2.13-30.62, P = .002). In a subgroup analysis, similar results were found that favorable CCR group achieved a higher proportion of 90-day mRS 0-3.

Conclusions: The favorable collateral circulation including arterial inflow combined with venous outflow in AIS-LVO patients with extensive baseline infarction is associated with better clinical outcomes. CCR status could serve as a valuable imaging biomarker for outcomes prediction.