Differential Benefit of Collaterals for Stroke Patients Treated with Thrombolysis or Supportive Care

Schuler, Felix; Rotkopf, Lukas T.; Apel, Daniel; Fabritius, Matthias P.; Tiedt, Steffen; Wollenweber, Frank Arne; Kellert, Lars; Dorn, Franziska; Liebig, Thomas; Thierfelder, Kolja M.; Kunz, Wolfgang G.

doi:10.1007/s00062-019-00815-y

Cited by 3 publications

(3 citation statements)

References 40 publications

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“…The extent of LMCs varies in humans and rodents 12 . In stroke patients, extensive LMCs are associated with better outcome after thrombolysis and mechanical thrombectomy [13][14][15] . While LMCs alleviate the severity of ischemic injury, little is known about how differences in collateral extent affect reperfusion after recanalization.…”

Section: Mainmentioning

confidence: 99%

Leptomeningeal collaterals regulate reperfusion in ischemic stroke

Binder

Amki

Glueck

et al. 2023

Preprint

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Recanalization is the mainstay of ischemic stroke treatment. However, even with timely clot removal, many stroke patients recover poorly. Leptomeningeal collaterals (LMCs) are pial anastomotic vessels with yet unknown functions. Utilizing a thrombin-based mouse model of stroke and the gold standard fibrinolytic treatment rt-PA, we here show that LMCs play a critical role in preserving vascular function in ischemic territories. We applied laser speckle contrast imaging, ultrafast ultrasound, and two-photon microscopy, to show that after thrombolysis, LMCs allow for gradual reperfusion resulting in small infarcts. On the contrary, in mice with poor LMCs, distal segments of recanalized arteries collapse and deleterious hyperemia causes hemorrhage and mortality. Accordingly, in stroke patients with poor collaterals undergoing thrombectomy, rapid reperfusion resulted in hemorrhagic transformation and unfavorable recovery. Thus, we identify LMCs as key components regulating reperfusion after stroke. Future therapeutic interventions should aim to enhance collateral function, allowing for gradual reperfusion of ischemic tissues after stroke.

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Section: Mainmentioning

confidence: 99%

Leptomeningeal collaterals regulate reperfusion in ischemic stroke

Binder

Amki

Glueck

et al. 2023

Preprint

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“… 24 If IVT is not used for recanalization, good collateral blood flow may have limited prognostic value. 25 …”

Section: Discussionmentioning

confidence: 99%

“…24 If IVT is not used for recanalization, good collateral blood flow may have limited prognostic value. 25 Lp-PLA2 is a calcium-independent phospholipase A2 that circulates in plasma with lipoprotein particles. Increased circulating LP-PLA2 levels can help predict increased risks of MI, stroke, and cardiovascular death.…”

Section: Discussionmentioning

confidence: 99%

Negative correlation between early recovery and lipoprotein-associated phospholipase A2 levels after intravenous thrombolysis

Wang

Guo

et al. 2022

J Int Med Res

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Objective Lipoprotein-associated phospholipase A2 (Lp-PLA2) is considered a biomarker for systemic inflammation and the risk of myocardial infarction and stroke. However, little is known about the effect of acute vascular events on marker levels. The purpose of this study was to assess the potential association of early recovery with Lp-PLA2 levels in patients with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT). Methods Forty-three consecutive AIS patients who had their first stroke and were hospitalized within 5 hours of the onset of stroke were enrolled. All patients were treated with IVT using alteplase or urokinase. Plasma Lp-PLA2 levels were measured within 24 hours after IVT. Variables that showed a significant association with Lp-PLA2 in univariate analysis were included in the multivariate ordered logistic regression model. Results Early recovery was associated with Lp-PLA2 levels after IVT, and Lp-PLA2 levels tended to decrease with increased probability of early recovery. This study is the first to report a negative correlation between early recovery and Lp-PLA2 levels after IVT. Conclusion Early recovery after IVT was negatively correlated with Lp-PLA2 A2 levels.

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