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01-03-2019 | Stroke | Original Communication

Determining factors of better leptomeningeal collaterals: a study of 857 consecutive acute ischemic stroke patients

Authors: Stefania Nannoni, Gaia Sirimarco, Carlo W. Cereda, Dimitris Lambrou, Davide Strambo, Ashraf Eskandari, Pascal J. Mosimann, Max Wintermark, Patrik Michel

Published in: Journal of Neurology | Issue 3/2019

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.

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Title: Determining factors of better leptomeningeal collaterals: a study of 857 consecutive acute ischemic stroke patients
Authors: Stefania Nannoni
Gaia Sirimarco
Carlo W. Cereda
Dimitris Lambrou
Davide Strambo
Ashraf Eskandari
Pascal J. Mosimann
Max Wintermark
Patrik Michel
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Angiography
Dyslipidemia
Published in: Journal of Neurology / Issue 3/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-09170-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Determining factors of better leptomeningeal collaterals: a study of 857 consecutive acute ischemic stroke patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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