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Background <p>Collateral circulation influences outcomes in large-vessel occlusion (LVO) stroke, yet its modifying effect on endovascular therapy for intracranial atherosclerosis-related LVO (ICAS-LVO) remains uncertain. This study evaluated whether collateral status alters the association between stent-assisted thrombectomy and outcomes in anterior-circulation ICAS-LVO.</p> Methods <p>An analysis was performed on 271 anterior-circulation ICAS-LVO patients from the RESCUE-ICAS registry. Collateral status was graded using the Tan collateral score (0–1 = poor, 2–3 = good). Patients were treated with mechanical thrombectomy (MT) alone or MT with adjunctive stenting. The primary outcome was functional independence (modified Rankin Scale [mRS] = 0–2) at 90 days. Secondary outcomes included successful reperfusion (mTICI≥2b), symptomatic intracranial hemorrhage (sICH), and mortality.</p> Results <p>Among 271 patients, 172 (63.5% ) had good, and 99 (36.5%) had poor collaterals. In adjusted interaction models, stenting improved 90-day functional independence (aOR 3.22, <i>p</i> = 0.030) without significant stent–collateral interaction (<i>p</i> = 0.876). No significant interactions were observed for mortality (<i>p</i> = 0.847) or sICH (<i>p</i> = 0.909). A significant adjusted interaction was present for final recanalization (interaction OR 8.35, <i>p</i> = 0.044).</p> Conclusions <p>In anterior-circulation ICAS-LVO, adjunctive stenting was associated with improved functional outcomes across collateral strata, with collateral status showing some modification of the stent effect on angiographic success.</p>

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Collateral status and outcomes in ICAS-LVO: insights from the RESCUE-ICAS registry

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Mustafa Ismail,
  • Ahmad Abu Qdais,
  • Eyad Almallouhi,
  • Adam De havenon,
  • Basem Zaino,
  • Violiza Inoa,
  • Francesco Capasso,
  • Michael Nahhas,
  • Robert M. Starke,
  • Isabel Fragata,
  • Matthew T. Bender,
  • Krisztina Moldovan,
  • Ilko Maier,
  • Jonathan A. Grossberg,
  • Pascal Jabbour,
  • Edgar A. Samaniego,
  • Jan-Karl Burkhardt,
  • Mohamad Abdalkader,
  • Elizabeth Blalock,
  • Ameer E. Hassan,
  • David Altschul,
  • Justin Mascitelli,
  • Robert W. Regenhardt,
  • Stacey Wolfe,
  • Mohamad Ezzeldin,
  • Kaustubh Limaye,
  • Hosam Al Jehani,
  • Muhammad H. Niazi,
  • Nitin Goyal,
  • Mouhammad Jumaa,
  • Ramesh Grandhi,
  • Thanh N. Nguyen,
  • Shadi Yaghi,
  • Sami Al Kasab

摘要

Background

Collateral circulation influences outcomes in large-vessel occlusion (LVO) stroke, yet its modifying effect on endovascular therapy for intracranial atherosclerosis-related LVO (ICAS-LVO) remains uncertain. This study evaluated whether collateral status alters the association between stent-assisted thrombectomy and outcomes in anterior-circulation ICAS-LVO.

Methods

An analysis was performed on 271 anterior-circulation ICAS-LVO patients from the RESCUE-ICAS registry. Collateral status was graded using the Tan collateral score (0–1 = poor, 2–3 = good). Patients were treated with mechanical thrombectomy (MT) alone or MT with adjunctive stenting. The primary outcome was functional independence (modified Rankin Scale [mRS] = 0–2) at 90 days. Secondary outcomes included successful reperfusion (mTICI≥2b), symptomatic intracranial hemorrhage (sICH), and mortality.

Results

Among 271 patients, 172 (63.5% ) had good, and 99 (36.5%) had poor collaterals. In adjusted interaction models, stenting improved 90-day functional independence (aOR 3.22, p = 0.030) without significant stent–collateral interaction (p = 0.876). No significant interactions were observed for mortality (p = 0.847) or sICH (p = 0.909). A significant adjusted interaction was present for final recanalization (interaction OR 8.35, p = 0.044).

Conclusions

In anterior-circulation ICAS-LVO, adjunctive stenting was associated with improved functional outcomes across collateral strata, with collateral status showing some modification of the stent effect on angiographic success.