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. 2022 Sep;269(9):4708-4716.
doi: 10.1007/s00415-022-11099-7. Epub 2022 Apr 6.

Small vessel disease and collaterals in ischemic stroke patients treated with thrombectomy

Géraud Forestier #  1   2 , Rémi Agbonon #  3 , Nicolas Bricout  4 , Wagih Benhassen  3 , Guillaume Turc  5 , Martin Bretzner  4   6 , Marco Pasi  7 , Joseph Benzakoun  3 , Pierre Seners  5 , Thomas Personnic  7 , Laurence Legrand  3 , Denis Trystram  3 , Christine Rodriguez-Regent  3 , Andreas Charidimou  6 , Natalia S Rost  6 , Serge Bracard  8 , Frédéric Clarençon  9 , Omer F Eker  10 , Norbert Nighoghossian  11 , Charlotte Cordonnier  7 , Catherine Oppenheim  3 , Olivier Naggara  3 , Hilde Henon  7 , Grégoire Boulouis  3
Affiliations

Small vessel disease and collaterals in ischemic stroke patients treated with thrombectomy

Géraud Forestier et al. J Neurol. 2022 Sep.

Abstract

Background and purpose: To determine the influence of the cerebral small vessel disease (SVD) burden on collateral recruitment in patients treated with mechanical thrombectomy (MT) for anterior circulation acute ischemic stroke (AIS).

Methods: Patients with AIS due to large vessel occlusion (LVO) from the Thrombectomie des Artères Cérébrales (THRACE) trial and prospective cohorts from 2 academic comprehensive stroke centers treated with MT were pooled and retrospectively analyzed. Collaterals' adequacy was assessed using the American Society of Interventional and Therapeutic Radiology/Society of Interventional Radiology (ASITN/SIR) score on initial digital subtraction angiography and dichotomized as good (3,4) versus poor (0-2) collaterals. The SVD burden was rated with the global SVD score on MRI. Multivariable logistic regression analyses were used to determine relationships between SVD and ASITN/SIR scores.

Results: A total of 312 participants were included (53.2% males, mean age 67.8 ± 14.9 years). Two hundred and seven patients had poor collaterals (66.4%), and 133 (42.6%) presented with any SVD signature. In multivariable analysis, patients demonstrated worse leptomeningeal collaterality with increasing SVD burden before and after adjustment for SVD risk factors (adjusted odds ratio [aOR] 0.69; 95%CI [0.52-0.89] and aOR 0.66; 95%CI [0.5-0.88], respectively). Using individual SVD markers, poor collaterals were significantly associated with the presence of lacunes (aOR 0.40, 95% CI [0.20-0.79]).

Conclusion: Our study provides evidence that in patients with AIS due to LVO treated with MT, the burden of SVD assessed by pre-treatment MRI is associated with poorer recruitment of leptomeningeal collaterals.

Keywords: Cerebral small vessel disease; Collateral circulation; Magnetic resonance imaging; Stroke; Thrombectomy.

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References

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