Journal of Korean Neurosurgical Society

  • 제67권1호
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  • Pages.31-41
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  • 2024
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Impact of Collateral Circulation on Futile Endovascular Thrombectomy in Acute Anterior Circulation Ischemic Stroke

  • Yoo Sung Jeon (Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Hyun Jeong Kim (Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Hong Gee Roh (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Taek-Jun Lee (Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jeong Jin Park (Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Sang Bong Lee (Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Hyung Jin Lee (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jin Tae Kwak (School of Electrical Engineering, Korea University) ;
  • Ji Sung Lee (Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hee Jong Ki (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2023.07.01
  • 심사 : 2023.07.29
  • 발행 : 2024.01.01
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초록

Objective : Collateral circulation is associated with the differential treatment effect of endovascular thrombectomy (EVT) in acute ischemic stroke. We aimed to verify the ability of the collateral map to predict futile EVT in patients with acute anterior circulation ischemic stroke. Methods : This secondary analysis of a prospective observational study included data from participants underwent EVT for acute ischemic stroke due to occlusion of the internal carotid artery and/or the middle cerebral artery within 8 hours of symptom onset. Multiple logistic regression analyses were conducted to identify independent predictors of futile recanalization (modified Rankin scale score at 90 days of 4-6 despite of successful reperfusion). Results : In a total of 214 participants, older age (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.56 to 3.67; p<0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR, 1.12; 95% CI, 1.04 to 1.21; p=0.004), very poor collateral perfusion grade (OR, 35.09; 95% CI, 3.50 to 351.33; p=0.002), longer door-to-puncture time (OR, 1.08; 95% CI, 1.02 to 1.14; p=0.009), and failed reperfusion (OR, 3.73; 95% CI, 1.30 to 10.76; p=0.015) were associated with unfavorable functional outcomes. In 184 participants who achieved successful reperfusion, older age (OR, 2.30; 95% CI, 1.44 to 3.67; p<0.001), higher baseline NIHSS scores (OR, 1.12; 95% CI, 1.03 to 1.22; p=0.006), very poor collateral perfusion grade (OR, 4.96; 95% CI, 1.42 to 17.37; p=0.012), and longer door-to-reperfusion time (OR, 1.09; 95% CI, 1.03 to 1.15; p=0.003) were associated with unfavorable functional outcomes. Conclusion : The assessment of collateral perfusion status using the collateral map can predict futile EVT, which may help select ineligible patients for EVT, thereby potentially reducing the rate of futile EVT.

키워드

과제정보

This study was supported by the National Research Foundation of Korea as subject number "2020R1F1A1071619", "RS2023-00252980", the Ministry of Education of Korea as subject number "RS-2023-00248375", and the Ministry of Health and Welfare of Korea as subject number "RS-2023-00266130".

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