Association of leptomeningeal collateral status with clinical outcomes after endovascular thrombectomy in large-core infarction.

BACKGROUND

The prognostic significance of leptomeningeal collateral status in patients with acute large-core infarction undergoing endovascular thrombectomy (EVT) remains incompletely defined. We aimed to evaluate its impact using the Careggi Collateral Score (CCS).

METHODS

This post hoc analysis of a prospective multicenter cohort included patients with acute anterior circulation large-core infarction (Alberta Stroke Program Early CT Score [ASPECTS] 0-5) treated with EVT. Leptomeningeal collaterals were assessed on digital subtraction angiography using the CCS and categorized as poor (0-2) or good (3-4). The primary outcome was favorable functional outcome (modified Rankin Scale (mRS) score 0-3) at 90 days.

RESULTS

Among 490 patients, 134 (27.3%) had good collateral status. Good collateral status was associated with higher rates of favorable functional outcome (63.4% vs 27.0%; adjusted odds ratio (aOR), 3.08; 95% CI, 1.94-4.88; P < 0.01) and reduced mortality (18.7% vs 50.6%; aOR, 0.37; 95% CI, 0.22-0.63; P < 0.01). Good collateral status also was linked to lower risk of symptomatic intracranial hemorrhage (6.0% vs 16.0%; aOR, 0.44; 95% CI, 0.19-0.98; P = 0.04), but was not associated with successful reperfusion.

CONCLUSION

In this cohort of patients with acute large-core infarction undergoing EVT, good leptomeningeal collateral status was associated with improved functional outcomes, reduced mortality, and lower hemorrhage risk, and these associations did not differ significantly by reperfusion success.