In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
Abstract:
Background: Collateral circulation has repeatedly been cited as a decisive factor in successful angiographic and clinical outcomes after endovascular therapy, offering rational selection criteria. Identifying patients with a malignant collateral profile, portending poor outcome, would greatly enhance decision-making in acute stroke. We analyzed the IMS III dataset to delineate baseline predictors of poor angiographic collaterals. Methods: Collateral grade was prospectively evaluated by the angiography core lab in IMS III. Poor collaterals or a malignant collateral profile was defined as ASITN grade 0-1. Baseline clinical, laboratory and non-contrast CT variables were evaluated in univariate and multivariable logistic regression as predictors of the malignant collateral profile. Results: 278 patients (mean age 65.3±12.6 years, 54% women, median NIHSS 17 (IQR 13-20) had collateral grading assessed at angiography. Malignant collaterals (ASITN 0-1) were noted in 77/278 (28%). Univariate analyses revealed that only history of HTN (88.3 vs. 71.0%, p=0.004), CHF (17.6 vs.8.0%, p=0.040), admission DBP (89±24 vs. 81±17 (mm Hg, mean±SD), p=0.002), NIHSS 〉 19 (40.3 vs. 28.4%, p=0.080), distal arterial occlusion location (p=0.002) and ASPECTS 0-4 (24.7 vs. 9.4%, p=0.002) were associated with malignant collaterals. Time from stroke onset to angiography was unrelated to collateral grade. Predictors in multivariable analyses included ASPECTS 0-4 (OR 3.72, 95%CI (1.60-8.66), p=0.002), HTN (OR 2.33, 95%CI (1.01-5.38), p=0.047), NIHSS 〉 19 (OR 2.26, 95%CI (1.16-4.40), p=0.017), distal arterial occlusion (OR 2.08, 95%CI (1.43-3.04), p 〈 0.001) and higher admission DBP (OR 1.02 per mm Hg, 95%CI (1.00-1.03), p=0.035). When ASPECTS 5-10, only NIHSS 〉 19 (OR 2.81, 95%CI (1.35-5.86), p=0.006) and distal arterial occlusion (OR 2.58, 95%CI (1.70-3.92), p 〈 0.001) predicted malignant collaterals. Conclusions: Elevated diastolic blood pressure, history of hypertension, NIHSS 〉 19, lower ASPECTS and distal arterial occlusion are strong predictors of the malignant collateral profile. Future studies should validate and implement a concomitant risk score for triage of acute stroke patients.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.46.suppl_1.wp12
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2015
detail.hit.zdb_id:
1467823-8
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