Collaterals at angiography guide clinical outcomes after endovascular stroke therapy in HERMES

David S Liebeskind¹, Marie K Luff², Serge Bracard³, Francis Guillemin⁴, Reza Jahan⁵, Tudor G Jovin⁶, Charles B L M Majoie⁷, Peter J Mitchell⁸, Aad van der Lugt⁹, Bijoy K Menon¹⁰, Luis San Roman¹¹, Bruce Campbell¹², Keith W Muir¹³, Michael D Hill^{14

15}, Diederik W J Dippel¹⁶, Jeffrey L Saver¹⁷, Andrew M Demchuk^{14

15}, Antoni Davalos¹⁸, Phil White¹⁹, Scott B Brown²⁰, Mayank Goyal²¹; HERMES Collaborators

Affiliations

¹ Neurology, University of California Los Angeles (UCLA), Los Angeles, California, USA davidliebeskind@yahoo.com.
² University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
³ Diagnostic and Interventional Neuroradiology, University of Lorraine, Nancy, France.
⁴ University of Lorraine, Nancy, France.
⁵ Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.
⁶ Neurology, Cooper University Hospital, Camden, New Jersey, USA.
⁷ Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁸ Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁹ Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
¹⁰ Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada.
¹¹ Neurointerventional Department, Hospital Clinic, Barcelona, Spain.
¹² Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Missouri, Australia.
¹³ School of Psychology and Neuroscience, University of Glasgow, Glasgow, UK.
¹⁴ Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
¹⁵ Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada.
¹⁶ Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
¹⁷ Comprehensive Stroke Center and Neurology, David Geffen School of Medicine, Los Angeles, California, USA.
¹⁸ Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
¹⁹ Institute of Neuroscience, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.
²⁰ Altair Biostatistics, Mooresville, North Carolina, USA.
²¹ Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.

PMID: 38991735
DOI: 10.1136/jnis-2024-021808

Collaterals at angiography guide clinical outcomes after endovascular stroke therapy in HERMES

David S Liebeskind et al. J Neurointerv Surg. 2025.

. 2025 Jul 14;17(8):811-816.

doi: 10.1136/jnis-2024-021808.

Authors

Affiliations

¹ Neurology, University of California Los Angeles (UCLA), Los Angeles, California, USA davidliebeskind@yahoo.com.
² University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
³ Diagnostic and Interventional Neuroradiology, University of Lorraine, Nancy, France.
⁴ University of Lorraine, Nancy, France.
⁵ Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.
⁶ Neurology, Cooper University Hospital, Camden, New Jersey, USA.
⁷ Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁸ Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁹ Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
¹⁰ Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada.
¹¹ Neurointerventional Department, Hospital Clinic, Barcelona, Spain.
¹² Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Missouri, Australia.
¹³ School of Psychology and Neuroscience, University of Glasgow, Glasgow, UK.
¹⁴ Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
¹⁵ Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada.
¹⁶ Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
¹⁷ Comprehensive Stroke Center and Neurology, David Geffen School of Medicine, Los Angeles, California, USA.
¹⁸ Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
¹⁹ Institute of Neuroscience, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.
²⁰ Altair Biostatistics, Mooresville, North Carolina, USA.
²¹ Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.

PMID: 38991735
DOI: 10.1136/jnis-2024-021808

Abstract

Background: Robust collateral circulation has been linked with better reperfusion and clinical outcomes. It remains unclear how individual assessments of collateral circulation may be translated into clinical practice.

Methods: The pooled Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) angiography dataset was analyzed by a centralized, independent imaging core blinded to other clinical data. Conventional angiography was acquired immediately prior to endovascular therapy. Collaterals were graded with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN) system and associated with baseline patient characteristics, reperfusion, and day 90 modified Rankin Score (mRS). Both 90-day all-cause mortality and day 90 mRS were modeled via multivariable logistic regression.

Results: Angiography was available in 376/605 (62%) patients. Baseline ASPECTS (Alberta Stroke Program Early CT Score) (p=0.043), history of diabetes mellitus (p=0.048), site of occlusion (p<0.001), and degree of subsequent Thrombolysis in Cerebral Infarction (TICI) reperfusion (p<0.001) were associated with collateral grades. ASITN collateral grade was strongly associated with ordinal mRS from baseline to 90 days in an unadjusted analysis (p<0.001). Multivariable regression demonstrated that collateral status is a strong determinant of mRS outcome in the presence of other predictors (OR=1.37 per grade, 95% CI [1.05 to 1.74], p=0.018). By comparing ORs, 1 unit of ASITN was determined to be approximately equivalent to 4.5 points of NIHSS, 11 years of age, 1.5 points of ASPECTS, or 100 min less delay from onset to puncture, in terms of impact on mRS.

Conclusions: Individual collateral physiology may contribute significantly to reperfusion success and clinical outcomes after acute ischemic stroke. Building a consensus for the role of angiographic collateral assessment in the allocation of adjuvant reperfusion therapies may help galvanize a precision medicine approach in stroke.

Keywords: Angiography; Artery; Blood Flow; Stroke; Thrombectomy.

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Conflict of interest statement

Competing interests: DSL reports having received grant funding from NINDS and consulting fees as an imaging core laboratory from Cerenovus, Genentech, Medtronic, Stryker, and Rapid Medical. RJ reports consulting with Phenox Medical, Microvention Terumo, and RapidPulse Inc. CBLMM reports having received grant funding from the CVON/Dutch Heart Foundation, Healthcare Evaluation Netherlands, European Commission, TWIN Foundation, and unrestricted grants from Stryker and Boehringer Ingelheim (all paid to institution) and is shareholder of Nicolab (minority interest). AvdL reports consulting fees from Stryker and grant funding from the Dutch Heart Foundation, AngioCare BV, Medtronic/Covidien/EV3®, MEDAC Gmbh/LAMEPRO, Penumbra Inc., Top Medical/Concentric, and Stryker, received by the Erasmus University Medical Center. LSR serves on a Data and Safety Monitoring Board ( DSMB) for somatosensory evoked potentials (SEP) monitoring in patients with acute ischemic stroke and large anterior vessel occlusion undergoing endovascular thrombectomy. A clinical validation of the Brain20® medical device, Promise20. AD reports grants from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health and unrestricted grants from Penumbra Inc., Stryker, Medtronic, and Thrombolytic Science, all for research. JLS reports consulting fees for advising on rigorous and safe clinical trial design and conduct from Abbott, Acticor, Aeromics, Amgen, Argenica, Astrocyte, Bayer, Biogen, Boehringer Ingelheim, BrainsGate, BrainQ, CSL Behring, Filterlex, Genentech, Johnson & Johnson, MindRhythm, Medtronic, NeuroMerit, Neuronics, Novo Nordisk, Occlutech, Phenox, Phillips, QuantalX, Rapid Medical, Roche, and Stream Biomedical. PJM reports unrestricted institutional scientific grants from Stryker and Medtronic. KWM reports consultancies with Boehringer Ingelheim, Biogen, Hyperfine, and lecture fees from Boehringer Ingelheim, IschemaView, and Brainomix. PW discloses institutional research grant support within the last 2 years from Microvention Terumo. He declares the following relevant professional relationships: Chair of the European Society of Minimally Invasive Neurotherapeutics Guidelines Committee, sits on the Policy Working Group for Thrombectomy of NHS England, and represents the Royal College of Radiologists on the UK Intercollegiate Stroke Working party - none of these are associated with financial reimbursement. He reports the following modest consultancy work: member of Stryker’s Global Hemorrhagic Stroke Advisory Board and educational consultancy work for Microvention Terumo. He has no other interests to declare. MG reports being the principal investigator of an unrestricted research grant to the University of Calgary for the HERMES collaboration by Medtronic. He also reports consulting services with Medtronic, Stryker, Microvention, and Cerenovus, and a licensing agreement with GE Healthcare regarding systems of acute stroke diagnosis.

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Collaterals at angiography guide clinical outcomes after endovascular stroke therapy in HERMES

Affiliations

Collaterals at angiography guide clinical outcomes after endovascular stroke therapy in HERMES

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms

LinkOut - more resources

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