Cerebral collateral cascade associated with infarct growth rate in ischemic stroke patients undergoing endovascular treatment

Background

Variability in infarct growth rate(IGR) is strongly associated with clinical outcomes in acute ischemic stroke(AIS) patients receiving endovascular treatment(EVT). Recently, the cerebral collateral cascade(CCC) has been shown to be related to imaging and clinical outcomes in AIS. Therefore, we investigated the association between CCC and IGR.

Methods

This was a multicenter retrospective study for AIS patients receiving EVT. IGR was calculated as the ischemic core volume on perfusion computed tomography divided by the time from stroke onset to imaging. Cerebral collateral circulation was assessed using the CCC, which integrated arterial collaterals, tissue-level collaterals, and venous outflow. Multivariable regression was applied to determine factors associated with IGR.

Results

A total of 321 patients were included. The median ischemic core volume was 12.5 mL, and the median IGR was 3.0 mL/h. Multivariable regression analysis showed that compared with patients in the CCC_– group, those in the CCC_mixed(β = −21.43, 95 % CI −35.08 to −7.79; P = 0.002) and CCC₊(β = −34.15, 95 % CI −49.90 to −18.40; P < 0.001) groups had significantly lower IGR. Similar associations were observed in both the elderly and late-window cohorts. Additionally, the NIHSS score at admission and ICA occlusion were significantly associated with IGR (P < 0.05). Furthermore, the diagnostic performance of CCC was significantly better than that of Tan scale (P = 0.001), VO (P < 0.001), or HIR (P = 0.001) as assessed by DeLong’s test.

Conclusion

CCC profiles were strongly associated with infarct progression in AIS patients undergoing EVT. These findings might help us understand the rule of occurrence and development of infarction progression.