Article Figures & Data
Figures
- Fig 1.
Flow chart description of patient selection and exclusion for the study. IAT indicates intra-arterial treatment.
- Fig 2.
Unadjusted predicted probability of favorable outcome at 3 months by time-to-reperfusion based on collateral-flow grades 0–1 (red line) versus 2–4 (blue line). Solid lines represent the probability of favorable outcome over onset-to-reperfusion time (A) and puncture-to-reperfusion time (B) as predicted by an unadjusted logistic regression model based on collateral-flow grade. Dashed lines show the 95% confidence intervals. Outcomes of each observed case are also indicated on the basis of collateral-flow grades 0–1 (red diamond) versus 2–4 (blue square).
- Fig 3.
A–D, The effect of time-to-reperfusion on clinical and imaging outcomes based on collateral-flow grade. a indicates logistic regression analysis adjusted for age, baseline NIHSS score, and posttreatment TICI 2b–3 reperfusion; b, logistic regression analysis adjusted for age, baseline NIHSS score, posttreatment TICI 2b–3 reperfusion, and onset-to-puncture time; c, linear regression analysis adjusted for age, baseline NIHSS score, posttreatment TICI 2b–3 reperfusion, and onset-to-puncture time.
- Fig 4.
Simplified illustration, which represents the unique effect of time-to-reperfusion on clinical outcome based on proposed collateral scenarios (modified from Liebeskind's illustrations31). A, Universally poor collaterals, which may show large infarcts and severe neurologic deficits at the time of presentation. B, Rapidly failing collaterals, which may show small-to-medium infarcts and severe neurologic deficits at the time of presentation. C, Slowly failing collaterals, which may show small infarcts and moderate-to-severe neurologic deficits at the time of presentation. D, Universally good collaterals, which may show tiny-to-small infarcts and mild-to-moderate neurologic deficits at the time of presentation. In real clinical practice, patients in scenarios B and C can be ideal candidates for endovascular reperfusion. However, the clinical outcome is limited by time-to-reperfusion in scenario B (eg, onset-to-reperfusion within 300 minutes or puncture-to-reperfusion within 60 minutes in this study).
Tables
Baseline characteristics, imaging, and clinical outcomes (N = 207)a
Characteristics Collateral-Flow Grade P Value 0–1 (n = 76) 2–4 (n = 131) Age (yr) 69 (62–76) 67 (58–73) .105 Male 50 (65.8%) 75 (57.3%) .226 Baseline NIHSS 17 (13–21) 16 (12–19) .041 Baseline ASPECTSDWIb 7 (5–8) 8 (6–9) .004c SBP (mm Hg) 148 (131–176) 146 (126–168) .520 DBP (mm Hg) 82 (72–90) 82 (71–97) .470 Blood glucose level (mg/dL) 126 (117–156) 126 (111–159) .861 Occlusion site .000 ICA-T or ICA-L 38 (50.0%) 22 (16.8%) MCA M1 26 (34.2%) 103 (78.6%) ICA/M1 tandem 12 (15.8%) 6 (4.6%) IV rtPA 41 (53.9%) 62 (47.3%) .359 Onset-to-puncture (min) 220 (160–290) 245 (175–325) .055 Puncture-to-reperfusion (min) 77 (54–104) 66 (44–90) .053 Onset-to-reperfusion (min) 297 (224–383) 307 (244–395) .342 3-Month favorable outcome 35 (46.1%) 82 (62.6%) .021 Procedure-related complications 4 (5.3%) 8 (6.1%) 1.000c Symptomatic ICH 4 (5.3%) 6 (4.6%) 1.000c Ischemic brain edema 7 (9.2%) 8 (6.1%) .406 Mortality 11 (14.5%) 13 (9.9%) .324 Note:—SBP indicates systolic blood pressure; DBP, diastolic blood pressure; ICH, intracranial hemorrhage.
↵a Numbers in parentheses are median (interquartile range) or number (%).
↵b Two hundred one DWI images at baseline (72 in 0–1 and 129 in 2–4; 97.1% in total) were available for ASPECTSDWI analysis.
↵c Fisher exact test for categoric variables/Mann-Whitney U test for continuous variables.
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