ORIGINAL RESEARCH article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
Angiographic Collateral Status Predicts Functional Outcome and Early Neurological Deterioration in Large-Vessel Occlusion Stroke Treated with Endovascular Therapy
Provisionally accepted
- 1Department of Neurology, West China School of Medicine, Sichuan University, Sichuan University affiliated Chengdu Second People’s Hospital, Chengdu Second People’s Hospital, Chengdu, China
- 2Bai Lian chi Community Health Center, Chenghua District, Chengdu, China
- 3Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Despite successful recanalization with endovascular treatment (EVT) for acute ischemic stroke (AIS), many patients experience poor outcomes. While collateral circulation is a known prognostic factor, its dynamic assessment via digital subtraction angiography (DSA) and its relationship to outcomes post-EVT require further investigation. Methods: This single-center retrospective study analyzed 185 consecutive AIS patients with large vessel occlusion treated with EVT. Collateral status was graded on pre-treatment DSA using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale and categorized as poor, fair, or good. The primary outcome was functional independence (modified Rankin Scale [mRS] score 0-2) at 90 days. Secondary outcomes included early neurological deterioration (END) within 7 days and 90-day mortality. Results: Patients with good collaterals had significantly higher rates of functional independence (66.1%) compared to those with fair (45.9%) and poor collaterals (13.2%). Conversely, the incidences of END (1.8% vs. 8.2% vs. 23.5%) and 90-day mortality (1.8% vs. 11.5% vs. 27.9%) were progressively lower in the good, fair, and poor collateral groups, respectively. Multivariable logistic regression confirmed that a higher collateral score was an independent predictor of good functional outcome and was independently associated with a lower risk of END and mortality. Conclusion: DSA-assessed collateral status is a strong independent predictor of 90-day functional outcome, END, and mortality in AIS patients following EVT. Robust pretreatment collaterals are associated with markedly improved recovery and survival, highlighting the critical prognostic value of collateral assessment in guiding treatment and patient management.
Keywords: Acute ischemic stroke, Collateral Circulation, Early neurological deterioration, endovascular treatment, functional outcome, Mortality
Received: 01 Dec 2025; Accepted: 02 Feb 2026.
Copyright: © 2026 Li, Chen, Lu, Li, Wang, He and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Junying Li
Dan Yang
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.