Collateral Score Complements Clot Location in Predicting the Outcome of Intravenous Thrombolysis

Abstract

BACKGROUND AND PURPOSE: Collateral circulation is an important determinant of stroke outcome. We studied the impact of leptomeningeal collateral circulation with respect to the location of the thrombus in predicting the clinical outcome of patients treated with intravenous thrombolytic therapy (MATERIALS AND METHODS: Anterior circulation thrombus was detected with CT angiography in 105 patients. Baseline clinical and imaging information was collected, and the site of the occlusion was recorded. Collaterals were assessed by using a 5-grade collateral score and were entered into logistic regression analysis to predict favorable clinical outcome (3-month modified Rankin Scale score of 0–2). RESULTS: Two-thirds of patients with a proximal occlusion displayed poor collateral filling (collateral score 0–1), whereas in more distal clot locations, approximately one-third had poor collaterals. Only 36% of patients with a proximal occlusion and good collaterals experienced favorable clinical outcome. In multivariate analysis, both clot location and collateral score were highly significant (P = .003 and P = .001) and independent predictors of favorable clinical outcome. Good collateral status increased the odds of favorable clinical outcome about 9-fold (OR = 9.3; 95% CI, 2.4–35.8). After dichotomization, a distal clot location had a larger odds ratio (OR = 13.3; 95% CI, 3.0–60.0) compared with the odds ratio of good collaterals (OR = 5.9; 95% CI, 1.8–19.0). CONCLUSIONS: A proximal occlusion in the anterior circulation is associated with poorer collateral status compared with a more distal occlusion. Both the clot location and collateral score are important and independent predictors of favorable clinical outcome of hyperacute stroke treated with intravenous thrombolysis. The location of the clot is a stronger determinant of the outcome than the collateral score.