Stroke: Removal of thrombus after stroke, collateral circulation suggests a better prognosis

The carotid artery innervates the speed and severity of cerebral ischemia, distinguishing between rapid or slow progress and corresponding treatment opportunities
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Most of the previous literature focuses on acute ischemic stroke patients in the early treatment window (within 6 hours from the last known well), while in the late window (>6 hours from the last known well), continuous collateral perfusion or collateral failure The characteristics of the fate are not obvious
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Surprisingly, in the recent post-mortem analysis of the DEFUSE-3 trial (endovascular treatment after imaging evaluation of ischemic stroke), single-phase computed tomography (CT) angiography (CTA) was performed during the late treatment window after stroke Good collaterals are related to smaller ischemic core volume at baseline and reduced ischemic core growth, but not to better functional outcomes, the success of endovascular treatment, hemorrhagic complications, or death
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The DAWN trial (Diffusion-Weighted Imaging or Computed Tomography Perfusion Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo) showed that in stroke patients caused by large vessel occlusion, the last known time is 6 Until 24 hours ago, the severity of clinical dysfunction did not match the infarct volume.
Compared with pure medical care, the functional outcome of thrombectomy was better at 90 days
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In this way, David S.
Liebeskind and others of UCLA conducted a post-mortem analysis of the DAWN trial to explore the characteristics and effects of appendages in the late time window of acute stroke patients
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DAWN imaging core laboratory performs baseline computed tomography angiography (CTA; intravascular and control group) and digital subtraction angiography (DSA; intravascular group only), using Tan score for CTA bypass and ASITN score for DSA bypass (American Society of Interventional and Therapeutic Neuroradiology Bypass Score)
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161 DAWN subjects (mean age 69.

In 3 levels of collateral flow (good, fair, and poor), baseline NIHSS, blood glucose <150, diabetes , previous ischemic stroke, baseline and 24-hour core infarct volume, baseline and 24-hour Alberta stroke plan early CT There are differences in scores, rapid progression of infarction, final thrombolytic therapy 2b+ for cerebral infarction, and death
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In the endovascular treatment group, collateral blood flow was an important predictor of the 90-day modified Rankin scale score of 0 to 2, 43.

The important significance of this study is that it found that: DAWN subjects were admitted to the hospital 6 to 24 hours after the onset, with limited infarct cores , and extensive collateral grades on CTA and DSA
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Original source:
Liebeskind DS, Saber H, Xiang B, et al.