To determine the association between cerebral collateral circulation status and cerebral small vessel disease (CSVD) burden.

Subclinical ischemia is thought to play a central role in CSVD pathogenesis. In patients with large vessel occlusion, good collaterals on initial presentation are associated with improved outcomes. The relationship between an increased burden of CSVD and collateral network has not been explored in the setting of thrombectomy. 

This was a retrospective single-center cohort of consecutive   patients with anterior circulation large vessel occlusions with   available brain MRI and CT-Angiogram. We identified the burden of individual CSVD markers[white matter hyperintensities    (WMH), cerebral microbleeds(CMB), lacunes, and enlarged    perivascular spaces (EPVS)] and computed the global CSVD  burden on MRI obtained in the acute stroke. We used the Tan Collateral score (CS) in CT-Angiogram to grade collaterals (0-3; 0=absent supply, 3=100% collateral supply). We performed univariable and multivariable adjusted analyses to explore the association between    collaterals and CSVD. 

237 patients (66.1±16.8 years), 123(52%) female were included.  Mean CS was 2(IQR 1-3). WMH (89%), basal ganglia EPVS (77%) and centrum semiovale EPVS (77%) were the most prevalent markers. Older age(beta=0.15,p<0.0001) had the most potent association with individual CSVD markers and higher global CSVD burden.  Older age(beta=-0.01,p=0.002) was associated with lower CS. Although a trend was detected between lower CS score and higher WMH burden, it did not reach statistical significance after adjusting for confounders (beta=-0.21,p=0.15).

In this cohort of large vessel occlusion patients, we found that older age is associated with higher individual CSVD marker and global CSVD burden and poor collateral status. We did not find an overt association between CS and WMH or global CSVD burden.