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

Authors

• 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

Publication/Presentation Date

8-5-2026

Abstract

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.

ISSN

1432-1920

Published In/Presented At

Ismail, M., Abu Qdais, A., Almallouhi, E., De Havenon, A., Zaino, B., Inoa, V., Capasso, F., Nahhas, M., Starke, R. M., Fragata, I., Bender, M. T., Moldovan, K., Maier, I., Grossberg, J. A., Jabbour, P., Samaniego, E. A., Burkhardt, J. K., Abdalkader, M., Blalock, E., Hassan, A. E., … Kasab, S. A. (2026). Collateral status and outcomes in ICAS-LVO: insights from the RESCUE-ICAS registry. Neuroradiology, 10.1007/s00234-026-04125-2. Advance online publication. https://doi.org/10.1007/s00234-026-04125-2

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

42554836

Department(s)

Administration and Leadership

Document Type

Article