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Author: search.filters.author.Andrés RoldánStart date: 2020

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    Item type:Publication,
    Collateral status predicts functional outcome in early-treated large-core anterior circulation stroke
    (Frontiers Media SA, 2026-04-14)
    Andrés Gallardo
    ;
    LAVADOS GERMAIN, PABLO MANUEL  
    ;
    Pablo Albiña-Palmarola
    ;
    Gabriel Cavada
    ;
    Andrés Roldán
    <jats:sec> <jats:title>Background and purpose</jats:title> <jats:p>Endovascular therapy (EVT) is increasingly offered to patients with large-core acute ischemic stroke (AIS), yet outcomes remain highly heterogeneous. Collateral circulation may be a key determinant of infarct evolution and recovery, but its role in early-window large-core stroke is not fully defined.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We retrospectively analyzed consecutive adults from a prospective stroke registry who presented within 6 h with anterior-circulation large-vessel occlusion, NIHSS ≥6, and a large ischemic core (MRI core &amp;gt;50 mL or CT perfusion core &amp;gt;70 mL, up to 150 mL). All patients received reperfusion therapy (intravenous thrombolysis, EVT, or both). Collateral status on baseline single-phase CTA was graded using the Tan scale (0–3); no patients had grade 3. The primary outcome was 90-day modified Rankin Scale (mRS); secondary outcome was NIHSS at discharge.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p> Fifty-four patients met inclusion criteria (Tan 0: <jats:italic>n</jats:italic> = 24; Tan 1: <jats:italic>n</jats:italic> = 14; Tan 2: <jats:italic>n</jats:italic> = 16). Baseline NIHSS, ASPECTS, and core volume were similar across groups. Patients without collaterals (Tan 0) had worse 90-day outcomes (median mRS 4 [IQR 3–6]) compared with those with Tan 1 (2 [IQR 1–3]) or Tan 2 (1 [IQR 1–2]) collaterals (both p &amp;lt; 0.001), whereas Tan 1 and Tan 2 did not differ significantly ( <jats:italic>p</jats:italic> = 0.27). NIHSS at discharge showed a similar gradient. In proportional-odds logistic regression, each one-grade increase in collateral status was associated with lower odds of worse 90-day mRS (adjusted per-grade OR 0.32; 95% CI 0.15–0.68; <jats:italic>p</jats:italic> = 0.003). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>In early-treated large-core AIS, even simple CTA-based collateral assessment strongly predicts recovery. Patients with absent collaterals follow a distinctly poorer trajectory, while those with any collateral filling behave more favorably. Incorporating collateral status into routine evaluation may improve prognostic accuracy and support treatment decisions in this challenging subgroup.</jats:p> </jats:sec>
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