Association of Estimated Arterial Stiffness with Collateral Status and Functional Outcome after Endovascular Thrombectomy: A Secondary Analysis of the OPTIMAL-BP Trial

PURPOSE: Estimated pulse wave velocity (ePWV) is a surrogate of arterial stiffness that may influence stroke outcomes and potentially affect collateral circulation. We examined the association of ePWV with collateral status and 3-month functional outcome after successful endovascular thrombectomy and explored the contribution of collateral status to this relationship across blood pressure (BP) management strategies. MATERIALS AND METHODS: In this secondary analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control trial, 285 patients were analyzed. Collateral status was assessed using the Tan scale (poor, 0-1; good, 2-3). Poor functional outcome was defined as 3-month modified Rankin Scale score of 3-6. Multivariable logistic and mediation analyses were performed to evaluate the association between ePWV and functional outcomes and to explore direct and indirect pathways. RESULTS: A total of 285 patients were included (mean age, 73.3±11.3 years; 40.4% women). Each 1 m/s increase in ePWV was associated with poor collaterals (adjusted odds ratio [OR] 1.276, 95% confidence interval [CI] 1.083-1.503) and poor functional outcome (adjusted OR 1.338, 95% CI 1.121-1.597). In mediation analyses, collateral status accounted for only a small proportion of the association between ePWV and poor functional outcome (indirect effect: adjusted β 0.022, 95% CI 0.001-0.053), whereas the direct effect remained significant (adjusted β 0.237, 95% CI 0.115-0.359). Neither the direct effect of ePWV on functional outcome nor the indirect effect through collateral status differed according to BP management strategy. CONCLUSION: Higher ePWV was associated with poor collateral status and unfavorable functional outcome after successful reperfusion. Collateral status accounted for only a small proportion of the observed association between ePWV and functional outcome.

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Journal
Neurointervention
Published
2026-10-08
DOI
https://doi.org/10.5469/neuroint.2026.00822
Primary Topic
Acute Ischemic Stroke Management
Type
article
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article

Association of Estimated Arterial Stiffness with Collateral Status and Functional Outcome after Endovascular Thrombectomy: A Secondary Analysis of the OPTIMAL-BP Trial

JoonNyung Heo, Jang‐Hyun Baek, Ji Hoe Heo, Young Dae Kim et al.
Neurointervention
Acute Ischemic Stroke Management
article

Association of Estimated Arterial Stiffness with Collateral Status and Functional Outcome after Endovascular Thrombectomy: A Secondary Analysis of the OPTIMAL-BP Trial

JoonNyung Heo, Jang‐Hyun Baek, Ji Hoe Heo, Young Dae Kim, Seong Hwan Ahn, Byung Moon Kim, Yo Han Jung, Yoonkyung Chang, Jae‐Joong Kim, Jae Wook Jung, Hye Sun Lee, Eunjeong Park, Jun Young Chang, Hyungwoo Lee, Hyo Suk Nam, Jeong‐Ho Hong, Soyoung Jeon, Oh Young Bang, Chi Kyung Kim, Dong Hoon Shin, Han‐Jin Cho, Joonsang Yoo, Na‐Young Shin, Kwon–Duk Seo, Sukyoon Lee, Sung‐Il Sohn, Minho Han, Bang‐Hoon Cho, Gyu Sik Kim, Tae‐Jin Song, Hyungjong Park, Chan Joo Lee, Minyoul Baik, Yang‐Ha Hwang, Dong Joon Kim, Sungha Park, Joung-Woo Choi, Kijeong Lee, Jung Hwa Seo, Sun Uck Kwon, Jae Guk Kim, Haram Joo, Il Hyung Lee, Jaeseob Yun, Kwang Hyun Kim, the OPTIMAL-BP trial investigators
article en

Abstract

PURPOSE: Estimated pulse wave velocity (ePWV) is a surrogate of arterial stiffness that may influence stroke outcomes and potentially affect collateral circulation. We examined the association of ePWV with collateral status and 3-month functional outcome after successful endovascular thrombectomy and explored the contribution of collateral status to this relationship across blood pressure (BP) management strategies. MATERIALS AND METHODS: In this secondary analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control trial, 285 patients were analyzed. Collateral status was assessed using the Tan scale (poor, 0-1; good, 2-3). Poor functional outcome was defined as 3-month modified Rankin Scale score of 3-6. Multivariable logistic and mediation analyses were performed to evaluate the association between ePWV and functional outcomes and to explore direct and indirect pathways. RESULTS: A total of 285 patients were included (mean age, 73.3±11.3 years; 40.4% women). Each 1 m/s increase in ePWV was associated with poor collaterals (adjusted odds ratio [OR] 1.276, 95% confidence interval [CI] 1.083-1.503) and poor functional outcome (adjusted OR 1.338, 95% CI 1.121-1.597). In mediation analyses, collateral status accounted for only a small proportion of the association between ePWV and poor functional outcome (indirect effect: adjusted β 0.022, 95% CI 0.001-0.053), whereas the direct effect remained significant (adjusted β 0.237, 95% CI 0.115-0.359). Neither the direct effect of ePWV on functional outcome nor the indirect effect through collateral status differed according to BP management strategy. CONCLUSION: Higher ePWV was associated with poor collateral status and unfavorable functional outcome after successful reperfusion. Collateral status accounted for only a small proportion of the observed association between ePWV and functional outcome.

Neurointervention
Ewha Womans University (KR), Chosun University (KR), Yonsei University (KR), Severance Hospital (KR), Dong-A University Hospital (KR), Kyungpook National University Hospital (KR), Asan Medical Center (KR), Samsung Medical Center (KR), Kyungpook National University (KR), University of Ulsan (KR), Seoul Medical Center (KR), Gachon University Gil Medical Center (KR), Chosun University Hospital (KR), Kangbuk Samsung Hospital (KR), Inje University Busan Paik Hospital (KR), Daejeon Eulji Medical Center, Eulji University (KR), National Health Insurance Service Ilsan Hospital (KR), CHA University Bundang Medical Center (KR), Gangnam Severance Hospital (KR), CHA University (KR), Kyung Hee University Hospital at Gangdong (KR), Yonsei University Health System (KR), Kyungpook National University Chilgok Hospital (KR), Ewha Womans University Mokdong Hospital (KR), Korea University Guro Hospital (KR), Keimyung University Daegu Dongsan Hospital (KR), Yongin Severance Hospital (KR), Korea University Anam Hospital (KR), Keimyung University Dongsan Hospital (KR), Ewha Womans University Seoul Hospital (KR), Pusan National University (KR), Dong-A University (KR), Keimyung University (KR), Sungkyunkwan University (KR)
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Acute Ischemic Stroke Management
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