ASSESSMENT OF COLLATERAL BLOOD FLOW AS A PREDICTOR OF ENDOVASCULAR THROMBECTOMY EFFICACY IN ACUTE ISCHEMIC STROKE

 

Domashenko M.A.¹, Konstantinov V.I.², Loskutnikov M.A.³,

Zaliautdinova R.Iu.², Vishnevskii Y.V.², Tanashyan M.M.⁴

 

1 - M.V. Lomonosov Moscow State University. Moscow, Russia.

2 - Central Clinical Medical-Sanitary Hospital. Magnitogorsk, Russia.

3 -  Central Clinical Hospital. Novosibirsk, Russia.

4 - Research Center of Neurology. Moscow, Russia.

Е

ndovascular thrombectomy (ET) is an effective reperfusion therapy method for carefully selected patients with ischemic stroke (IS). One of the predictors of its effectiveness is the state of collateral blood flow (collaterals) – the degree of development and functional involvement of collateral arteries in the area of ischemic lesion. Currently, there is no consensus on how collateral status (CS) should influence decision-making regarding reperfusion therapy tactics.

Purpose. To assess the influence of CS on the functional outcome of stroke in the anterior circulation after performing ET within the first 6 hours of IS.

Materials and methods. A retrospective study included 267 patients (137 (51.3%) men, 130 (46.8%) women, mean age 69.4 years) with IS who underwent endovascular treatment within the first 6 hours of the disease. Reperfusion achievement was assessed using the modified Thrombolysis in Cerebral Infarction (mTICI) scale, and collaterals were assessed using the ASITN/SIR scale during digital subtraction angiography performed as part of the endovascular intervention. The severity of neurological deficits was assessed on admission using the NIHSS scale, and functional outcome at discharge and on day 90 after stroke was assessed using the modified Rankin Scale.

Results and discussion. Before the start of ET, 134 (50.2%) patients had an ASITN/SIR score of 0-1 (poor CS), while 133 (49.8%) patients had moderate to good CS (ASITN/SIR 2-3). A positive correlation was demonstrated between CS and achieving reperfusion on mTICI, and a negative correlation with the initial severity by NIHSS scale. Poor CS was associated with a higher likelihood of poor functional outcome at discharge and on day 90 post-stroke, and was also a predictor of mortality on day 90. In patients who achieved mTICI 2b-3 reperfusion good collaterals demonstrated prognostic significance for achieving a favorable outcome, while poor CS was associated with mortality on day 90 after stroke.

Conclusion. CS has prognostic value in determining the functional outcomes of IS in the anterior circulation in patients who underwent ET within the first 6 hours of stroke and can be considered when selecting patients for endovascular intervention.

 

Keywords: ischemic stroke, endovascular thrombectomy, collateral blood flow, digital subtraction angiography.

 

Corresponding author: Domashenko M.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Domashenko M.A., Konstantinov V.I., Loskutnikov M.A., Zaliautdinova R.Iu., Vishnevskii Y.V., Tanashyan M.M. Assessment of collateral blood flow as a predictor of endovascular thrombectomy efficacy in acute ischemic stroke. REJR 2025; 15(4):20-33. DOI: 10.21569/2222-7415-2025-15-4-20-33.

Received: 08.12.25                 Accepted: 18.12.25