Collateral circulation and multidimensional outcomes after endovascular thrombectomy for anterior-circulation stroke: A retrospective cohort study.

BACKGROUND

Outcomes after endovascular thrombectomy (EVT) for anterior-circulation large-vessel occlusion remain heterogeneous. We evaluated whether pretreatment angiographic collateral grade was associated with a broad spectrum of post-EVT outcomes.

METHODS

We retrospectively studied consecutive patients with anterior-circulation large-vessel occlusion treated with endovascular thrombectomy (EVT) and pretreatment American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral grading. The primary outcome was 90-day favorable functional outcome (mRS 0-2). Secondary outcomes included mortality, hemorrhagic transformation, symptomatic intracranial hemorrhage, malignant brain edema, early neurological deterioration (END), and ordinal mRS shift. Sequential models adjusted for baseline covariates, internal carotid artery (ICA) occlusion, and additional clinical, imaging, inflammatory, and procedural variables.

RESULTS

Among 718 patients, 665 had 90-day mRS data. ASITN/SIR grades 0, 1, 2, and 3 occurred in 154 (21.4%), 145 (20.2%), 396 (55.2%), and 23 (3.2%) patients, respectively. Favorable outcome increased from 31.2% to 63.6% across grades, whereas mortality decreased from 51.8% to 18.2%. After ICA adjustment, each 1-grade increase remained associated with favorable outcome (OR, 1.283; 95% CI, 1.033-1.593), lower mortality (OR, 0.697; 95% CI, 0.559-0.869), hemorrhagic transformation (OR, 0.770; 95% CI, 0.631-0.939), malignant brain edema (OR, 0.483; 95% CI, 0.298-0.782), END (OR, 0.788; 95% CI, 0.647-0.961), and favorable ordinal mRS shift (OR, 1.316; 95% CI, 1.093-1.585). These associations were attenuated after additional adjustment.

CONCLUSION

Pretreatment ASITN/SIR collateral grade was associated with a broad spectrum of post-EVT outcomes. Attenuation after additional clinical, imaging, inflammatory, and procedural adjustment should be interpreted as exploratory and hypothesis-generating rather than as evidence of causal mediation.