Stefania Nannoni1, Gaia Sirimarco2, Carlo W Cereda2,3, Dimitris Lambrou2, Davide Strambo2, Ashraf Eskandari2, Pascal J Mosimann4, Max Wintermark5, Patrik Michel2. 1. Stroke Center, Neurology Service, Lausanne University Hospital, Rue du Bugnon, 46, 1011, Lausanne, Switzerland. Stefania.Nannoni@chuv.ch. 2. Stroke Center, Neurology Service, Lausanne University Hospital, Rue du Bugnon, 46, 1011, Lausanne, Switzerland. 3. Stroke Center, Neurology Service, Neurocenter of Southern Switzerland, Ospedale Civico di Lugano, Lugano, Switzerland. 4. Neuroradiology Division, Department of Radiology, Inselspital, Bern, Switzerland. 5. Neuroradiology Division, Department of Radiology, Stanford University and Medical Center, Stanford, USA.
Abstract
BACKGROUND: 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. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.
BACKGROUND: 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 AISpatients with middle cerebral artery (MCA) occlusion. METHODS: 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). RESULTS: 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). CONCLUSIONS: Younger age, dyslipidemia and lower creatinine levels were predictors of better collaterals in AISpatients 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.
Authors: T Hashimoto; T Kunieda; T Honda; F Scalzo; L Ali; J D Hinman; N M Rao; M Nour; M Bahr-Hosseini; J L Saver; R Raychev; D Liebeskind Journal: AJNR Am J Neuroradiol Date: 2021-11-18 Impact factor: 3.825
Authors: M Laflamme; S Carrondo-Cottin; M-M Valdès; D Simonyan; M-È Audet; J-L Gariépy; M-C Camden; C Gariépy; S Verreault; P Lavoie Journal: AJNR Am J Neuroradiol Date: 2022-09-22 Impact factor: 4.966
Authors: Adnan Khan; Ajay Menon; Naveed Akhtar; Saadat Kamran; Ahmad Muhammad; Georgios Ponirakis; Hoda Gad; Ioannis N Petropoulos; Faisal Wadiwala; Blessy Babu; Adeeb M Narangoli; Pablo G Bermejo; Hanadi Al Hamad; Marwan Ramadan; Peter Woodruff; Mark Santos; Maher Saqqur; Ashfaq Shuaib; Rayaz A Malik Journal: Sci Rep Date: 2021-10-05 Impact factor: 4.379