Abstract Details

Title The Absence of Collaterals is Associated with Larger Infarct Volume and Worse Outcome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-047

Objective Assess the use of collateral score in predicting clinical outcome and final infarct volume in LVO patients with mild symptoms.

Background Recent trials have proven the effectiveness of mechanical thrombectomy (MT) in patients with anterior circulation large vessel occlusion (LVO) and severe stroke symptoms, little is known however about the best treatment for patients with LVO and mild symptoms.

Design/Methods A retrospective review of prospectively collected data on patients presenting with mild ischemic stroke (NIHSS < 6) and LVO between 09/2015 and 07/2017 was performed. Collected data included demographics, admission NIHSS, ASPECTS, occlusion location, collateral score, final infarct volume, and 90-day mRS scores. Patients who underwent MT were excluded from our analysis. A negative binomial distributed generalized linear regression model, with a log link as well as generalized linear regression model was used for these analyses.

Results 41 patients were identified. Mean age was 67.8, 92.7% were white, and 56.1% were male. Median admission NIHSS was 3. The most common vessels involved was MCA (63.3%, M2 = 34.7%), ICA (34.7%), and ACA (2%). Twelve patients received tPA. Mean ASPECTS was 9, mean collateral score was 2. Mean infarct volume was 18.6 mL. A good functional outcome (mRS 0-2) at 90 days was achieved in 81 % of patients. A spearman Rho correlation coefficient was used to evaluate the relationship between collateral score and final infarct volume. There was a negative relationship between collateral score and final infarct volume (-0.3134, P=0.046). Logistic regression showed that with a one-point increase in admission NIHSS there was a 22% higher chance of a 4mL increase in final infarct volume. Higher infarct volume was associated with lower odds of achieving good functional outcome (mRS 0-2) (RR 0.99, P=0.022 [95% CI 0-978-0.98]).

Conclusions The absence of collaterals correlates with a larger final infarct volume and a worse long-term functional outcome.

Authors/Disclosures
Eric Kimmel, MD PRESENTER	No disclosure on file
Sami Alkasab, MD (MUSC)	Dr. Alkasab has nothing to disclose.
	No disclosure on file
	No disclosure on file
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH. The institution of Dr. Ortega Gutierrez has received research support from PCORI.
Kaustubh S. Limaye, MD (Indiana University School of Medicine)	Dr. Limaye has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Scientia Vascular.
Ann Van De Walle Jones, MD (Indiana University)	Dr. Van De Walle Jones has nothing to disclose.
Enrique C. Leira, MD, MS, FAAN (University of Iowa Department of Neurology, Comprehensive Stroke Center)	Dr. Leira 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 AHA. The institution of Dr. Leira has received research support from NIH-NINDS.
David Hasan	No disclosure on file
Edgar Samaniego, MD, FAAN (University of Iowa Hospital and Clinics)	Dr. Samaniego has received personal compensation for serving as an employee of University of Iowa. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Terumo Neuro. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rapid Medical. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for J&J Neuro. Dr. Samaniego has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Metronic. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as a Consultant for iSchemaView. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Society of Neurointerventional Surgery. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Neurointerventional Surgery.

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