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Open Access

Effect of thrombectomy on oedema progression and clinical outcome in patients with a poor collateral profile

Gabriel Broocks, Andre Kemmling, Tobias Faizy, Rosalie McDonough, Noel Van Horn, Matthias Bechstein, Lukas Meyer, Gerhard Schön, Jawed Nawabi, Jens Fiehler, Helge Kniep, Uta Hanning
DOI: 10.1136/svn-2020-000570 Published 28 June 2021
Gabriel Broocks
1 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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  • ORCID record for Gabriel Broocks
Andre Kemmling
2 Institute of Neuroradiology, University Hospital of Luebeck, Luebeck, Germany
3 Neuroradiology, Westpfalzklinikum, Kaiserslautern, Germany
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Tobias Faizy
4 Department of Diagnostic and Interventional Neuroradiology, Stanford University, Stanford, California, USA
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Rosalie McDonough
1 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Noel Van Horn
1 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Matthias Bechstein
1 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lukas Meyer
1 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Gerhard Schön
5 Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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Jawed Nawabi
6 Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Jens Fiehler
1 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Helge Kniep
1 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Uta Hanning
1 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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  • Figure 1
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    Figure 1

    Illustration of recanalisation versus persistent vessel occlusion in two patients. Both patients presented with a low Alberta Stroke Program Early CT Score (ASPECTS) and poor collateral status at admission. The patient in the upper row did not undergo endovascular treatment and exhibited a significantly aggravated oedema formation in follow-up imaging. The patient in the lower row presented with an even lower ASPECTS of 3, but showed less oedema formation in follow-up imaging. CTA,CT angiography; MIP, maximum intensity projection; NECT, non-enhanced CT; NMU,net water uptake.

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    Figure 2

    Regression analyses for clinical outcome and lesion pathophysiology. The impact of endovascular recanalisation in patients with poor intracranial collaterals (X axis) on modified ranking scale (mRS) score at 90 days (left), ischaemic lesion water uptake (middle) and total lesion volume (right) based on multivariable linear regression analysis. Ordinal mRS values were treated as scaled variable for linear regression. FCT, follow-up CT.

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    Figure 3

    Clinical outcome, quantitative lesion water uptake and total lesion volume in the study cohort. Boxplots to illustrate differences in clinical outcome, indicated by modified ranking scale scores (mRS) at 90 days (left), per cent lesion water uptake in follow-up CT (FCT, middle) and total lesion volume (right) in patients with successful vessel recanalisation versus persistent vessel occlusion. NWU, netwater uptake.

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  • Table 1

    Characteristics of patients with poor collaterals (n=129)

    Patient characteristicsVessel
    recanalisation
    Persistent vessel
    occlusion
    Group comparison
    P value
    Subjects, n (%)87 (67)42 (33)na
    Age in years, median (IQR)76 (65–82)73 (69–84)0.62
    Female sex, n (%)36 (42)17 (41)0.89
    Admission NIHSS, median (IQR)17 (15–20)19 (17–20)0.03
    ASPECTS, median (IQR)6 (5–8)4 (3–5)<0.001
    Time onset to imaging in hours, mean (SD)2.9 (2.1)3.7 (1.6)0.03
    Mechanical thrombectomy, n (%)87 (100)17 (41)<0.01
    Collateral Score, median (IQR)1 (1–2)1 (0–1)0.003
    Initial NWU in %, mean (SD)11.0 (5.6)10.6 (4.3)0.69
    Follow-up endpoints
    Follow-up infarct volume in mL, median (IQR)35 (13-129)150 (90-206)<0.001
    Follow-up NWU in %, mean (SD)19.5 (6.0)26.8 (6.4)<0.001
    mRS, median (IQR)*4.5 (2–6)5 (5–6)<0.001
     mRS 0–2, n (%)23 (26)1 (2)<0.001
     mRS 3–4, n (%)19 (22)7 (17)1.0
     mRS 5–6, n (%)42 (48)33 (79)<0.001
     *mRS score not available, n31
    • mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; NWU, net water uptake.

Supplementary Materials

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    [svn-2020-000570supp001.pdf]

Additional Files

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    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
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Effect of thrombectomy on oedema progression and clinical outcome in patients with a poor collateral profile
Gabriel Broocks, Andre Kemmling, Tobias Faizy, Rosalie McDonough, Noel Van Horn, Matthias Bechstein, Lukas Meyer, Gerhard Schön, Jawed Nawabi, Jens Fiehler, Helge Kniep, Uta Hanning
Stroke and Vascular Neurology Jun 2021, 6 (2) 222-229; DOI: 10.1136/svn-2020-000570

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Effect of thrombectomy on oedema progression and clinical outcome in patients with a poor collateral profile
Gabriel Broocks, Andre Kemmling, Tobias Faizy, Rosalie McDonough, Noel Van Horn, Matthias Bechstein, Lukas Meyer, Gerhard Schön, Jawed Nawabi, Jens Fiehler, Helge Kniep, Uta Hanning
Stroke and Vascular Neurology Jun 2021, 6 (2) 222-229; DOI: 10.1136/svn-2020-000570
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Effect of thrombectomy on oedema progression and clinical outcome in patients with a poor collateral profile
Gabriel Broocks, Andre Kemmling, Tobias Faizy, Rosalie McDonough, Noel Van Horn, Matthias Bechstein, Lukas Meyer, Gerhard Schön, Jawed Nawabi, Jens Fiehler, Helge Kniep, Uta Hanning
Stroke and Vascular Neurology Jun 2021, 6 (2) 222-229; DOI: 10.1136/svn-2020-000570
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