M Ichijo1, E Iwasawa2, Y Numasawa2, K Miki3, S Ishibashi4, M Tomita5, H Tomimitsu6, T Kamata7, H Fujigasaki8, S Shintani6, H Mizusawa2. 1. From the Department of Neurology and Neurological Science (M.I., E.I., Y.N., S.I., and H.M.) Department of Neurology, Musashino Red Cross Hospital (M.I., T.K.), Tokyo, Japan. 2. From the Department of Neurology and Neurological Science (M.I., E.I., Y.N., S.I., and H.M.). 3. Department of Endovascular Surgery (K.M.). 4. From the Department of Neurology and Neurological Science (M.I., E.I., Y.N., S.I., and H.M.) t-ishibashi.nuro@tmd.ac.jp. 5. Clinical Research Center (M.T.), Tokyo Medical and Dental University, Tokyo, Japan. 6. Department of Neurology, JA Toride Medical Center (H.T., S.S.), Ibaraki, Japan. 7. Department of Neurology, Musashino Red Cross Hospital (M.I., T.K.), Tokyo, Japan. 8. Department of Internal Medicine (H.F.), Metropolitan Bokutoh Hospital, Tokyo, Japan.
Abstract
BACKGROUND AND PURPOSE: Predicting response to rtPA is essential in the era of endovascular therapy for stroke. The purpose of this study was to elucidate prognostic factors of early neurologic improvement and long-term outcome with respect to the development and reversion of leptomeningeal collaterals in recanalization therapy after acute ischemic stroke. MATERIALS AND METHODS: We analyzed consecutive patients with proximal MCA occlusion treated with rtPA from 2007 to 2012 at 2 hospital stroke centers. All patients routinely underwent brain MR imaging before rtPA. To assess the reversion of collateral signs, we included patients who underwent follow-up MR imaging. We assessed the development and reversion of collaterals by using a combination of 2 MR imaging collateral markers, the hyperintense vessel sign and the posterior cerebral artery laterality sign. Early neurologic improvement was defined as a decrease in the NIHSS score of ≥10 or a score of ≤2 at 24 hours of treatment. RESULTS: Early neurologic improvement was observed in 22 of 48 eligible patients. The development of collaterals at arrival (15/22 versus 9/26, P = .042) was significantly associated with early neurologic improvement. Multivariate analysis adjusting for other variables showed that the development of collaterals at arrival (OR, 4.82; 95% CI, 1.34-19.98; P = .015) was independently associated with early neurologic improvement. Reversion of collaterals was significantly associated with successful recanalization (P < .001), and multivariate analysis showed that the reversion of collaterals was an independent prognostic factor of long-term functional outcome (OR, 5.07; 95% CI, 1.38-22.09; P = .013). CONCLUSIONS: Our results indicate that the development of leptomeningeal collaterals plays a crucial role in achieving early neurologic improvement, and reversion of collaterals predicts a favorable outcome via arterial recanalization after rtPA treatment for acute stroke.
BACKGROUND AND PURPOSE: Predicting response to rtPA is essential in the era of endovascular therapy for stroke. The purpose of this study was to elucidate prognostic factors of early neurologic improvement and long-term outcome with respect to the development and reversion of leptomeningeal collaterals in recanalization therapy after acute ischemic stroke. MATERIALS AND METHODS: We analyzed consecutive patients with proximal MCA occlusion treated with rtPA from 2007 to 2012 at 2 hospital stroke centers. All patients routinely underwent brain MR imaging before rtPA. To assess the reversion of collateral signs, we included patients who underwent follow-up MR imaging. We assessed the development and reversion of collaterals by using a combination of 2 MR imaging collateral markers, the hyperintense vessel sign and the posterior cerebral artery laterality sign. Early neurologic improvement was defined as a decrease in the NIHSS score of ≥10 or a score of ≤2 at 24 hours of treatment. RESULTS: Early neurologic improvement was observed in 22 of 48 eligible patients. The development of collaterals at arrival (15/22 versus 9/26, P = .042) was significantly associated with early neurologic improvement. Multivariate analysis adjusting for other variables showed that the development of collaterals at arrival (OR, 4.82; 95% CI, 1.34-19.98; P = .015) was independently associated with early neurologic improvement. Reversion of collaterals was significantly associated with successful recanalization (P < .001), and multivariate analysis showed that the reversion of collaterals was an independent prognostic factor of long-term functional outcome (OR, 5.07; 95% CI, 1.38-22.09; P = .013). CONCLUSIONS: Our results indicate that the development of leptomeningeal collaterals plays a crucial role in achieving early neurologic improvement, and reversion of collaterals predicts a favorable outcome via arterial recanalization after rtPA treatment for acute stroke.
Authors: Peter D Schellinger; Julio A Chalela; Dong-Wha Kang; Lawrence L Latour; Steven Warach Journal: AJNR Am J Neuroradiol Date: 2005-03 Impact factor: 3.825
Authors: Marc Ribo; Alan Flores; Marta Rubiera; Jorge Pagola; Joao Sargento-Freitas; David Rodriguez-Luna; Pilar Coscojuela; Olga Maisterra; Socorro Piñeiro; Francisco J Romero; Jose Alvarez-Sabin; Carlos A Molina Journal: Stroke Date: 2011-09-29 Impact factor: 7.914