Robust Collaterals Are Independently Associated With Excellent Recanalization in Patients With Large Vessel Occlusion Causing Acute Ischemic Stroke.

Background: In patients with acute ischemic stroke secondary to large vessel occlusion, achieving modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 (excellent recanalization) over mTICI 2b is associated with improved functional outcomes. We aimed to determine pretreatment and interventional parameters that are independently associated with mTICI 2c/3 over 2b reperfusion in patients who underwent technically successful mechanical thrombectomy. Methods: In this retrospective study, consecutive patients with acute ischemic stroke with anterior circulation large vessel occlusion achieving mTICI 2b/2c/3 recanalization after mechanical thrombectomy were included. We evaluated the association between pretreatment clinical, imaging, and interventional parameters in patients who achieved mTICI 2c/3 versus 2b using multivariate logistic regressions. Results: From May 11, 2019 to October 9, 2022, 149 consecutive patients met our inclusion criteria (median 70 years old [interquartile range 65-78.5], 57.7% female). Adjusted multivariate regression analyses showed that patients with excellent recanalization had lower admission National Institutes of Health Stroke Scale scores (adjusted odds ratio [aOR], 0.93; Conclusion: Robust collateral status defined by cerebral blood volume index ≥0.7 on pretreatment computed tomography perfusion, absence of prior stroke, and absence of diabetes are independently associated with excellent recanalization in patients with successfully recanalized acute ischemic stroke-large vessel occlusion. Our findings highlight the prognostic implications of robust collateral status and modifiable risk factors that may influence collateral status for maximizing the likelihood of excellent recanalization.