Collaterals at Angiography and Outcomes in the Interventional Management of Stroke (IMS) III Trial

David S LIEBESKIND; Thomas A TOMSICK; Osama O ZAIDAT; Syed I HUSSAIN; Mayank GOYAL; Bijoy K MENON; Firas Al Ali; Bernard YAN; Yuko Y PALESCH; Joseph P BRODERICK; Lydia D FOSTER; Sharon D YEATTS; Janice CARROZZELLA; Andrew M DEMCHUK; Tudor G JOVIN; Pooja KHATRI; Ruediger VON KUMMER; Rebecca M SUGG; Interventional Management of Stroke (IMS) III Investigators

doi:10.1161/STROKEAHA.113.004072

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Collaterals at Angiography and Outcomes in the Interventional Management of Stroke (IMS) III Trial

Journal article

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Collaterals at Angiography and Outcomes in the Interventional Management of Stroke (IMS) III Trial

David S LIEBESKIND, Thomas A TOMSICK, Osama O ZAIDAT, Syed I HUSSAIN, Mayank GOYAL, Bijoy K MENON, Firas Al Ali, Bernard YAN, Yuko Y PALESCH, Joseph P BRODERICK, …

Stroke (1970), Vol.45(3), pp.759-764

2014

DOI: 10.1161/STROKEAHA.113.004072

PMCID: PMC3977615

PMID: 24473178

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Abstract

Background and Purpose—Endovascular strategies provide unique opportunity to correlate angiographic measures of collateral circulation at the time of endovascular therapy. We conducted systematic analyses of collaterals at conventional angiography on recanalization, reperfusion, and clinical outcomes in the endovascular treatment arm of the Interventional Management of Stroke (IMS) III trial. Methods—Prospective evaluation of angiographic collaterals was conducted via central review of subjects treated with endovascular therapy in IMS III (n=331). Collateral grade before endovascular therapy was assessed with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale, blinded to all other data. Statistical analyses investigated the association between collaterals with baseline clinical variables, angiographic measures of recanalization, reperfusion and clinical outcomes. Results—Adequate views of collateral circulation to the ischemic territory were available in 276 of 331 (83%) subjects. Collateral grade was strongly related to both recanalization of the occluded arterial segment (P=0.0016) and downstream reperfusion (P<0.0001). Multivariable analyses confirmed that robust angiographic collateral grade was a significant predictor of good clinical outcome (modified Rankin Scale score ≤2) at 90 days (P=0.0353), adjusted for age, history of diabetes mellitus, National Institutes of Health Stroke Scale strata, and Alberta Stroke Program Early CT Score. The relationship between collateral flow and clinical outcome may depend on the degree of reperfusion. Conclusions—More robust collateral grade was associated with better recanalization, reperfusion, and subsequent better clinical outcomes. These data, from the largest endovascular trial to date, suggest that collaterals are an important consideration in future trial design.

Neurology

Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy

Biological and medical sciences

Vascular diseases and vascular malformations of the nervous system

Medical sciences

Nervous system (semeiology, syndromes)

Details

Title: Subtitle: Collaterals at Angiography and Outcomes in the Interventional Management of Stroke (IMS) III Trial
Creators: David S LIEBESKIND - UCLA Stroke Center, Los Angeles, CA, United States
Thomas A TOMSICK - University of Cincinnati, Cincinnati, OH, United States
Osama O ZAIDAT - Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI, United States
Syed I HUSSAIN - Michigan State University, East Lansing, MI, United States
Mayank GOYAL - Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Bijoy K MENON - Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Firas Al Ali - Summit Neurovascular Specialties and Akron General Hospital, Akron, OH, United States
Bernard YAN - Royal Melbourne Hospital, Parkville, Victoria, Australia
Yuko Y PALESCH - Medical University of South Carolina, Charleston, SC, United States
Joseph P BRODERICK - University of Cincinnati, Cincinnati, OH, United States
Lydia D FOSTER - Medical University of South Carolina, Charleston, SC, United States
Sharon D YEATTS - Medical University of South Carolina, Charleston, SC, United States
Janice CARROZZELLA - University of Cincinnati, Cincinnati, OH, United States
Andrew M DEMCHUK - Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Tudor G JOVIN - UPMC Stroke Institute, Pittsburgh, PA, United States
Pooja KHATRI - University of Cincinnati, Cincinnati, OH, United States
Ruediger VON KUMMER - Department of Neuroradiology, University of Dresden, Dresden, Germany
Rebecca M SUGG - University of Mississippi, Jackson, MS, United States
Interventional Management of Stroke (IMS) III Investigators
Contributors: Colin P Derdeyn (Contributor) - University of Iowa, Radiology
Resource Type: Journal article
Publication Details: Stroke (1970), Vol.45(3), pp.759-764
Publisher: Lippincott Williams & Wilkins; Hagerstown, MD
DOI: 10.1161/STROKEAHA.113.004072
PMID: 24473178
PMCID: PMC3977615
ISSN: 0039-2499
eISSN: 1524-4628
Language: English
Date published: 2014
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984013203402771

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