Leptomeningeal collaterals are associated with modifiable metabolic risk factors

Abstract

Objective We seek to identify potentially modifiable determinants associated with variability in leptomeningeal collateral status in patients with acute ischemic stroke. Methods Data are from the Keimyung Stroke Registry. Consecutive patients with M1 segment middle cerebral artery (MCA) ± intracranial internal carotid artery (ICA) occlusions on baseline CT-angiography (CTA) from May 2004 to July 2009 were included. Baseline and follow-up imaging was analyzed blinded to all clinical information. Two raters assessed leptomeningeal collaterals on baseline CTA by consensus, using a previously validated regional leptomeningeal score (rLMC). Results Baseline characteristics (n=206) were: mean age 66.9±11.6 years, median baseline NIHSS 14 (IQR 11-20), and median stroke symptom onset to CTA 166 minutes (IQR 96-262), Poor collateral status at baseline (rLMC score 0-10) was seen in 73/206 (35.4%). On univariate analyses, patients with poor collateral status at baseline were older, hypertensive, had higher white blood cell count, blood glucose, D-dimer, serum uric acid levels, and were more likely to have metabolic syndrome. Multivariable modeling identified metabolic syndrome (OR 3.22 95% CI 1.69-6.15, p<0.001), hyperuricemia (per 1 mg/dl OR 1.35 95% CI 1.12-1.62, p<0.01) and older age (per 10 years, OR 1.34 95% CI 1.02-1.77, p=0.03) as independent predictors of poor leptomeningeal collateral status at baseline. Conclusion Metabolic syndrome, hyperuricemia and age are associated with poor leptomeningeal collateral status in patients with acute ischemic stroke.

Thrombus Characteristics Are Related to Collaterals and Angioarchitecture in Acute Stroke

“…12,13 All patients underwent NCCT at admission followed by a CTA of the head and neck. Most patients also had a baseline magnetic resonance imaging (MRI) scan.…”

“…Leptomeningeal collaterals were assessed on baseline CTA by consensus (BKM, SIS) using the regional leptomeningeal score; a previously published ordinal scoring system based on the Alberta Stroke Program Early CT score template that has excellent interrater reliability. 12,13 Statistical Analyses Data are first described using standard descriptive statistics. Wilcoxon rank-sum test and Spearman's correlation coefficient were then used to compare nonparametric data between prespecified groups.…”

“…Collateral status and symptom onset to CT time were independent variables in model 1; this model also includes a two-way interaction term between collateral status and symptom onset to CT time. Collateral status was trichotomized into good (regional leptomeningeal score 17-20), intermediate (11)(12)(13)(14)(15)(16), and poor (0-10) for these analyses. 12 Model 2a used logistic regression with the hyperdense sign as a dependent variable, clot length and onset to CT time as independent variables, and a two-way multiplicative interaction term between the independent variables.…”

Early Reperfusion Rates with IV tPA Are Determined by CTA Clot Characteristics

“…Details of both registries have been described in previous publications. 10,19 Similarities and differences in baseline characteristics of patients in these registries are described in Table 1.…”

CTA Collateral Status and Response to Recanalization in Patients with Acute Ischemic Stroke

“…[3][4][5][6][7][8] This collateral circulation is highly variable and potentially influences the rate at which an infarct grows. 4,[8][9][10] Collateral status at baseline is an independent determinant of clinical outcome among patients with acute ischemic stroke. 3,5,7,8,11 Nonetheless, "effect modification" by collateral status measured noninvasively by use of CTA of the relationship between recanalization and clinical outcome has not been demonstrated before.…”