Abstract Details

Title Collaterals in the Interventional Management of Stroke (IMS) III Trial

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) IN7 - (-)

Poster/Presentation
Number 005

Objective

Background Collateral circulation may exert an influential effect on arterial recanalization, downstream angiographic and tissue reperfusion and ensuing clinical outcomes after revascularization for acute ischemic stroke. Endovascular strategies provide unique opportunity to correlate definitive angiographic measures of collaterals at the time of interventional therapy.

Design/Methods Prospective evaluation of angiographic collaterals was conducted via central review of all cases enrolled and treated in the endovascular arm of IMS III. Collateral grade was assessed with the ASITN/SIR scale on angiography at procedure start and immediately prior to intra-arterial treatment (time 0), blind to all other data. Statistical analyses investigated the association between collateral grade with baseline clinical data, angiographic measures of recanalization (AOL), angiographic reperfusion (TICI), and clinical outcomes.

Results From 2006-2012, 380 cases were prospectively evaluated for collateral grade at start of procedure and time 0 prior to treatment. Adequate collateral views were available in 283/380 (75%) cases at baseline, and 277/380 (73%) cases at time 0 and after subsequent treatment with intra-arterial tPA, EKOS, MERCI, Penumbra, and Solitaire devices. Detailed results will be presented at ISC in coordination with release of the primary trial results. The relationships between collateral flow grade and baseline clinical features (NIHSS and age), location of vascular occlusion at cerebral angiography, AOL recanalization and TICI reperfusion, and mROS of 0-2 at 90 days will be presented. Analyses will explore potential interactions between collateral flow grade with recanalization, angiographic reperfusion, and clinical outcome.

Conclusions Collateral circulation was available and prospectively evaluated in the largest endovascular therapy trial for stroke conducted to date. The role of collaterals may be an important consideration in the design of future endovascular trials.

Authors/Disclosures
David S. Liebeskind, MD, FAAN (Neurovascular Imaging Research Core at UCLA) PRESENTER	Dr. Liebeskind has received research support from Cerenovus. Dr. Liebeskind has received research support from Genentech . Dr. Liebeskind has received research support from Medtronic. Dr. Liebeskind has received research support from Stryker.
Thomas Tomsick (University Hospital)	No disclosure on file
Sharon Yeatts	No disclosure on file
	No disclosure on file
Tudor G. Jovin, MD (Cooper University Healthcare)	Dr. Jovin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Jovin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Contego Medical. Dr. Jovin has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Several law firms. Dr. Jovin has stock in Corindus. Dr. Jovin has stock in Methinks. Dr. Jovin has stock in Viz.ai. Dr. Jovin has stock in Route92. Dr. Jovin has stock in FreeOx Biotech. Dr. Jovin has stock in Galaxy. Dr. Jovin has stock in Kandu. The institution of Dr. Jovin has received research support from Stryker. The institution of Dr. Jovin has received research support from Medtronic.
Pooja Khatri, MD, FAAN (Univ of Cincinnati/Dept of Neuro)	The institution of Dr. Khatri has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lumosa. Dr. Khatri has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bayer. The institution of Dr. Khatri has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Diamedica. Dr. Khatri has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Basking Biosciences. Dr. Khatri has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Khatri has received research support from Cerenovus. Dr. Khatri has received publishing royalties from a publication relating to health care.
	No disclosure on file
Yuko Palesch	No disclosure on file
Joseph P. Broderick, MD, FAAN (University of Cincinnati)	Dr. Broderick has received publishing royalties from a publication relating to health care.
	No disclosure on file
James P. Wymer, MD, PhD, FAAN (Department of Neurology, University of Florida)	No disclosure on file

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