Determining factors of better leptomeningeal collaterals: a study of 857 consecutive acute ischemic stroke patients
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In acute ischemic stroke (AIS) collaterals correlate with infarct size, recanalization rate and clinical outcome. We aimed to identify factors associated with better collateral status in a large series of AIS patients with middle cerebral artery (MCA) occlusion.
In the Acute STroke Registry and Analysis of Lausanne (ASTRAL) from 2003 to 2016, we identified all consecutive AIS with proximal MCA occlusion on CT-angiography performed < 24 h. Collaterals were scored from 0 (absent) to 3 (≥ 100%) and related to multiple demographic, clinical, metabolic and radiological variables in a multivariate regression analysis (MVA).
The 857 included patients had a median age of 72.3 years, 48.4% were female and median admission NIHSS was 16. Better collaterals were associated with younger age (OR 0.99; 95% CI 0.98–1.00), hemineglect (OR 1.35; 95% CI 1.03–1.76), absence of visual field defects (OR 0.64; 95% CI 0.46–0.90), eye deviation (OR 0.58; 95% CI 0.43–0.79) and decreased vigilance (OR 0.62; 95% CI 0.44–0.88). Better collaterals were also associated with dyslipidemia (OR 1.57; 95% CI 1.16–2.13), no previous statin use (OR 0.69; 95% CI 0.50–0.95), and lower creatinine levels (OR 0.99; 95% CI 0.99–1.00). On neuroimaging, better collaterals related to higher ASPECTS score (OR 1.27; 95% CI 1.20–1.35) and higher clot burden score (OR 1.09; 95% CI 1.03–1.14).
Younger age, dyslipidemia and lower creatinine levels were predictors of better collaterals in AIS patients from proximal MCA occlusions. Greater degree of collaterals related to lower stroke severity on admission. On neuroimaging, better collaterals were independently associated with minor early ischemic changes and lower clot burden. These data may add knowledge on pathophysiology of collaterals development and may help to identify patients with better collaterals for late or aggressive recanalization treatments.
KeywordsAcute ischemic stroke Collateral circulation Computed tomography-angiography (CTA) Acute neuroimaging
Acute ischemic stroke
Clot burden score
Middle cerebral artery
We thank Melanie Price Hirt for English language correction and editing. We thank Dr Federico Ricciardi from University College London for helpful suggestions on this manuscript.
SN studied the concept and design, helped in analysis and interpretation, and preparation of the article. GS, CWC and DS helped in interpretation of data and critical revision of the article for important intellectual content. DL carried out data analysis and interpretation and helped in preparation of the article. AE helped in data acquisition and analysis. PJM helped in radiological data acquisition and critical revision of the article for important intellectual content. MW contributed to the conception and design, and helped in the interpretation of radiological data. PM studied the concept and design, and helped in data acquisition, analysis and interpretation, critical revision of the article for important intellectual content, study supervision.
This project was supported by the European Academy of Neurology and the Swiss Heart Foundation.
Compliance with ethical standards
Conflicts of interest
In the last 3 years, Prof. P. Michel received research grants from the Swiss Heart Foundation, Boehringer Ingelheim and BMS through his institution; speaker fees from Boehringer Ingelheim, Bayer, Daiichi Sankyo, Medtronic and Amgen; honoraria from scientific advisory boards from Boehringer Ingelheim, Bayer, Pfizer and BMS and consulting fees from Medtronic, Astra-Zeneca and Amgen. His institution (CHUV), receives all of the support for stroke education and research. Dr. G. Sirimarco served on scientific advisory boards for Amgen and Daiichi Sankyo. Dr. C.W. Cereda received research grants from the Swiss Heart Foundation, Advisory Board of Research (EOC) and Boehringer Ingelheim in the last 3 years through his institution; honoraria from scientific advisory boards from Boehringer Ingelheim, Bayer and Pfizer. The other authors report no conflicts of interest.
Collection, analysis and publication of data in ASTRAL was approved by the institution’s ethical commission.
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