OPTIMIZATION OF ENDOVASCULAR STRATEGY IN ACUTE ISCHEMIC STROKE CONSIDERING ANGIOARCHITECTURE AND COLLATERAL CIRCULATION
Keywords:
ischemic stroke, mechanical thrombectomy, collateral circulation, angioarchitecture, endovascular therapy, reperfusion, mTICI, First Pass Effect, CTA, CTPAbstract
Acute ischemic stroke remains a leading cause of mortality and long-term disability worldwide despite significant advances in reperfusion therapy. Modern endovascular treatment, particularly mechanical thrombectomy, has demonstrated high efficacy in restoring blood flow in large vessel occlusions. However, clinical outcomes remain heterogeneous, reflecting the complex interaction between vascular angioarchitecture, thrombus characteristics, and collateral circulation status.
Aim of the study. To evaluate the impact of angioarchitecture and collateral status on endovascular treatment outcomes and to develop an optimized algorithm for selecting thrombectomy techniques. A prospective cohort study was conducted including 148 patients with acute ischemic stroke who underwent multimodal imaging assessment, including CT, CTA, and CTP, followed by stratification according to the intervention strategy.
Results. Algorithm-based approach incorporating collateral circulation and vascular anatomy significantly increased the rate of complete reperfusion (mTICI 3), improved the likelihood of achieving the First Pass Effect, and enhanced functional outcomes at 90 days. Favorable collateral status was associated with reduced infarct growth and a higher probability of functional independence.
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