Predictors for the extent of pial collateral recruitment in acute ischemic stroke

Abstract

Background Pial arterioles can provide a variable degree of collateral flow to ischemic vascular territories during acute ischemic stroke. This study sought to identify predictive factors of the degree of pial collateral recruitment in acute ischemic stroke. Methods Clinical information and arteriograms from 62 consecutive patients with stroke due to either middle cerebral artery (MCA) M1 segment or internal carotid artery (ICA) terminus occlusion within 6 h following symptom onset were retrospectively reviewed. Pial collaterals were defined based on the extent of reconstitution of the MCA territory. Patients with slow antegrade flow distal to the occlusion site were excluded and no anesthetics were used prior or during angiography. Results were analyzed using multivariate nominal logistic regression. Results Better pial collateral recruitment was associated with proximal MCA versus ICA terminus occlusion ( p = 0.005; odds ratio (OR) = 9.3; 95% confidence interval (CI), 2.16–53.3), lower presenting National Institutes of Health Stroke Scale Score (NIHSSS) ( p = 0.023; OR = 6.51; 95% CI, 1.49–41.7), and lower diastolic blood pressure ( p = 0.0411; OR = 5.05; 95% CI, 1.20–29.2). Age, gender, symptom duration, diabetes, laterality, systolic blood pressure, glucose level, hematocrit, platelet level, and white blood cell count at presentation were not found to have a statistically significant association with pial collateral recruitment. Conclusions Extent of pial collateral recruitment is strongly associated with the occlusion site (MCA M1 segment versus ICA terminus) and less strongly associated with presenting NIHSSS and diastolic blood pressure.

Role of diabetes in collateral status assessed in CT perfusion–derived dynamic CTA in anterior circulation stroke

“…There is a controversial debate regarding the influence of diabetes on collaterals in acute ischemic stroke. While results of animal studies indicate a strong association between diabetes and collateral status [3][4][5], clinical studies based on single-phase collateral assessment report to the contrary [8,9,[16][17][18]. To our knowledge, this is the first study particularly analyzing the association of diabetes with collaterals based on dynamic/multiphase collateral assessment.…”

“…According to Christoforidis et al, blood glucose level was not associated with collaterals either. However, they included only 62 patients and used a collateral score that does not assess the spatial extent of collaterals [8]. Lazzaro et al…”

“…According to Christoforidis et al, blood glucose level was not associated with collaterals either. However, they included only 62 patients and used a collateral score that does not assess the spatial extent of collaterals [ 8 ]. Lazzaro et al ( n = 104) have reported no association of diabetes with collaterals using the Christoforidis score as well [ 9 ].…”

“…In contrast to the above-mentioned results of animal studies, clinical retrospective studies based on single-phase CT angiographies and single-phase collateral scores reported that diabetes is not associated with poor collaterals [ 8 , 9 ]. Single-phase collateral scores, however, have been shown to be inferior compared to multiphase scores, because they do not depict the time delay and the spatial extent of collateralization in the late venous phase and, hence, might underestimate the actual collateralization [ 10 , 11 ].…”

Blood Pressure Management in Acute Ischemic Stroke

“…The majority of studies indicate that higher acute phase BP is associated with better collaterals in ischemic stroke patients [48][49][50][51][52]. There is, however, some evidence from a few studies showing that lower BP may favor better pial collateral recruitment [53].…”