Abstract WP31: Asymmetrical Internal Veins Sign In Acute Ischemic Stroke: A New Marker For Poor Collateral Circulation.

INTRODUCTION: Changes in venous drainage imaging have been directly related to parenchymal damage in acute ischemic stroke during endovascular treatment. Venous asymmetry assessed by CT prior to treatment may be directly related to delayed flow in the hypoperfused territory. We investigated the prevalence of asymmetry in internal cerebral vein (AIV) drainage and its correlation with collateral flow in patients with acute ischemic stroke by a multimodal CT protocol. Subjects and methods: We retrospectively evaluated clinical and radiological data of 29 consecutive patients with acute anterior circulation ischemic stroke within 6 hours from symptoms onset. Collateral status was graded as good or poor depending on the extent of contrast visualized distal to the occlusion on CT angiography (CTA). Presence and AIV (analyzed by density units, time to peak and volume) and arterial collateral score were blinded assessed on CT perfusion (PCT), CTA source images (CTASI) and MIP reconstructions. Results: We included 29 patients, with a median age of 77 ± 15 y, and 31% of them were men. Median baseline NIHSS was 11 ± 7. Mean infarct ASPECTS was 9.3 ± 1 and size 2 cm3 ± 4. Asymmetrical veins were present in 33% of patients. This sign was more prevalent in patients with proximal occlusions than in distal occlusions (67% versus 33%) and in patients with poor collaterals compared to those with good collaterals (62% versus 29%). AIV was significantly associated with increasing age (p= 0.03), increasing baseline NIHSS (p= 0.02) and poor collaterals (p=0.01). Presence of AIV reached high specificity (93%) and good sensitivity (66%) for poor arterial collaterals prediction (p=0.001). Conclusion: Impairment of venous circulation, assessed by means of AIV, is present in one third of the patients and was associated with stroke severity and low effectiveness of collateral flow. Presence of internal veins asymmetry is highly specific in detecting poor collateral circulation in acute stroke and may be a predictor of clinical and radiological severity, possibly useful for patients selection in planning reperfusion therapy strategies.

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Abstract WP68: CT Perfusion Collateral Index in Assessment of Collaterals in Patients With Acute Ischemic Stroke: A New Imaging Biomarker

Stroke ◽

10.1161/str.51.suppl_1.wp68 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kambiz Nael ◽

Jonathan Larson ◽

Yu Sakai ◽

Jared Goldstein ◽

Jacob Deutsch ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Ct Perfusion ◽

Imaging Biomarker ◽

Collateral Flow ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Good Functional Outcome ◽

Infarction Volume

Purpose: Perfusion collateral index (PCI) has been recently defined as a promising measure of collateral flow. We aim to evaluate the collateral status via CT-based PCI in association with outcome measures such as final infraction volume, recanalization status and functional outcome in patients presenting with acute ischemic stroke (AIS) and in a comparative analysis against CTA and DSA collateral scores. Methods: AIS patients with anterior circulation large vessel occlusion who had baseline CTA and CT perfusion and underwent endovascular treatment were included. CTA collateral scores were calculated using modified Tan score and DSA collateral scores were evaluated by ASITN grading. In addition, previously described PCI defined as the volume of moderately hypoperfused tissue (ATD 2-6sec ) multiplied by its corresponding rCBV was calculated in each patient. The association of CTA and DSA collateral scores and PCI were assessed against 3 measured outcomes: 1) Final infarction volume obtained from follow up MRI; 2) Final recanalization status defined by TICI scores; 3) Functional outcome measured by 90-day mRS. Results: A total of 53 patients met inclusion criteria (27F; mean/SD age: 70.1 ± 13 years; median NIHSS: 14). Final infarction volume (mean/SD: 30/40 mL), excellent recanalization defined by TICI >2C was achieved in 36 (68%) patients, and 23 patients (43%) had good functional outcome (mRS <2). Having good collaterals on all 3 modalities (CTA, DSA, CTP-PCI) were associated with significantly (p<0.05) smaller infarction volume. However only good collaterals determined by CTP-PCI was predictive of achieving excellent recanalization (p=0.001) or good functional outcome (p=0.01) ( Figure 1 ). Conclusion: Collateral status assessed via CT-PCI outperforms CTA and DSA collateral scores in prediction of excellent recanalization and good functional outcome and may be a promising imaging biomarker of collateral status in patients with AIS.

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MR CLEAN-LATE, a multicenter randomized clinical trial of endovascular treatment of acute ischemic stroke in The Netherlands for late arrivals: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05092-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

F. A. V. ( Anne) Pirson ◽

◽

Wouter H. Hinsenveld ◽

Robert-Jan B. Goldhoorn ◽

Julie Staals ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Time Window ◽

Ct Perfusion ◽

Controlled Trial ◽

Stroke Severity ◽

Collateral Flow ◽

Open Label ◽

Link Type ◽

Mr Clean

Abstract Background Endovascular therapy (EVT) for acute ischemic stroke due to proximal occlusion of the anterior intracranial circulation, started within 6 h from symptom onset, has been proven safe and effective. Recently, EVT has been proven effective beyond the 6-h time window in a highly selected population using CT perfusion or MR diffusion. Unfortunately, these imaging modalities are not available in every hospital, and strict selection criteria might exclude patients who could still benefit from EVT. The presence of collaterals on CT angiography (CTA) may offer a more pragmatic imaging criterion that predicts possible benefit from EVT beyond 6 h from time last known well. The aim of this study is to assess the safety and efficacy of EVT for patients treated between 6 and 24 h from time last known well after selection based on the presence of collateral flow. Methods The MR CLEAN-LATE trial is a multicenter, randomized, open-label, blinded endpoint trial, aiming to enroll 500 patients. We will investigate the efficacy of EVT between 6 and 24 h from time last known well in acute ischemic stroke due to a proximal intracranial anterior circulation occlusion confirmed by CTA or MRA. Patients with any collateral flow (poor, moderate, or good collaterals) on CTA will be included. The inclusion of poor collateral status will be restricted to a maximum of 100 patients. In line with the current Dutch guidelines, patients who fulfill the characteristics of included patients in DAWN and DEFUSE 3 will be excluded as they are eligible for EVT as standard care. The primary endpoint is functional outcome at 90 days, assessed with the modified Rankin Scale (mRS) score. Treatment effect will be estimated with ordinal logistic regression (shift analysis) on the mRS at 90 days. Secondary endpoints include clinical stroke severity at 24 h and 5–7 days assessed by the NIHSS, symptomatic intracranial hemorrhage, recanalization at 24 h, follow-up infarct size, and mortality at 90 days, Discussion This study will provide insight into whether EVT is safe and effective for patients treated between 6 and 24 h from time last known well after selection based on the presence of collateral flow on CTA. Trial registration NL58246.078.17, ISRCTN19922220, Registered on 11 December 2017

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Prestroke statin use enhances collateralization in acute ischemic stroke patients

Restorative Neurology and Neuroscience ◽

10.3233/rnn-201012 ◽

2020 ◽

Vol 38 (4) ◽

pp. 311-321

Author(s):

Jiaying Zhu ◽

Mengmeng Ma ◽

Jinghuan Fang ◽

Jiajia Bao ◽

Shuju Dong ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Statin Therapy ◽

Cerebral Artery ◽

Functional Outcomes ◽

Collateral Circulation ◽

Stroke Severity ◽

Stroke Patients ◽

Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

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Abstract TP38: Core Growth Speed as a Marker of Collateral Circulation Status in Acute Ischemic Stroke with Known Onset Time

Stroke ◽

10.1161/str.48.suppl_1.tp38 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Laura Blanco-García ◽

Elisa Cortijo ◽

Mercedes De Lera ◽

Ana Calleja ◽

María Usero ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Collateral Circulation ◽

Cerebral Blood Volume ◽

Onset Time ◽

Growth Speed ◽

Infarct Core ◽

Anterior Circulation ◽

Unaffected Side ◽

Core Volume

Objective: We aimed to evaluate the parameter core growth speed (CGS) as a marker of collateral circulation status (CC) in acute ischemic stroke, and to compare it with other brain perfusion-derived markers of collateral capacity. Methods: We retrospectively studied acute ischemic stroke patients who were evaluated with urgent computed tomography perfusion (CTP) and CT angiography. Inclusion criteria comprised known time of onset and anterior circulation proximal occlusion. Collateral circulation was assessed on CTP-source images and rated as poor (0-1) vs. good (2-3) following a previously published scale. CTP maps were computed using Neuroscape 2.0 software by Olea Medical. Infarct core volume was calculated as the brain tissue with >70% reduction in cerebral blood flow (CBF) as compared to the unaffected side. CGS was obtained by dividing core volume by the time from stroke onset to CTP acquisition. Relative cerebral blood volume (rCBV), relative CBF, and hypoperfusion index ratio (HIR = Tmax>10s/Tmax>6s) were used as comparators. Results: We included 41 patients (mean age 71 years; median NIHSS 17; median onset-CTP time 150 minutes). We observed a positive correlation between CGS and HIR (ρ= 0.517 p< 0.001), and negative correlations between rCBV and CGS (ρ= -0.669 p<0.0001), and rCBF and CGS (ρ= -0.749 p<0.0001). Collateral circulation was categorized as poor or good in 15 and 26 patients respectively. A gradual descend in CGS was seen as CC improved (p=0.0005). A logistic regression model adjusted by rCBV, rCBF and HIR identified CGS as independently associated with CC. The association of CGS with good CC in a ROC curve was highly significant (p=0.002, area under the curve 0.8). Conclusion: Core growth speed is robustly associated with collateral circulation status. This parameter can be directly obtained from infarct core volume without the need to process other perfusion or angiographic images, if the time of onset is well known.

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Topographic correlation of infarct area on CT perfusion with functional outcome in acute ischemic stroke

Journal of Neurosurgery ◽

10.3171/2018.8.jns181095 ◽

2020 ◽

Vol 132 (1) ◽

pp. 33-41 ◽

Cited By ~ 3

Author(s):

Neil Haranhalli ◽

Nnenna Mbabuike ◽

Sanjeet S. Grewal ◽

Tasneem F. Hasan ◽

Michael G. Heckman ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Ct Perfusion ◽

Multivariable Analysis ◽

Reperfusion Therapy ◽

Infarct Core ◽

Anterior Circulation ◽

Logistic Regression Models ◽

Confounding Variables

OBJECTIVEThe role of CT perfusion (CTP) in the management of patients with acute ischemic stroke (AIS) remains a matter of debate. The primary aim of this study was to evaluate the correlation between the areas of infarction and penumbra on CTP scans and functional outcome in patients with AIS.METHODSThis was a retrospective review of 100 consecutively treated patients with acute anterior circulation ischemic stroke who underwent CT angiography (CTA) and CTP at admission between February 2011 and October 2014. On CTP, the volume of ischemic core and penumbra was measured using the Alberta Stroke Program Early CT Score (ASPECTS). CTA findings were also noted, including the site of occlusion and regional leptomeningeal collateral (rLMC) score. Functional outcome was defined by modified Rankin Scale (mRS) score obtained at discharge. Associations of CTP and CTA parameters with mRS scores at discharge were assessed using multivariable proportional odds logistic regression models.RESULTSThe median age was 67 years (range 19–95 years), and the median NIH Stroke Scale score was 16 (range 2–35). In a multivariable analysis adjusting for potential confounding variables, having an infarct on CTP scans in the following regions was associated with a worse mRS score at discharge: insula ribbon (p = 0.043), perisylvian fissure (p < 0.001), motor strip (p = 0.007), M2 (p < 0.001), and M5 (p = 0.023). A worse mRS score at discharge was more common in patients with a greater volume of infarct core (p = 0.024) and less common in patients with a greater rLMC score (p = 0.004).CONCLUSIONSThe results of this study provide evidence that several CTP parameters are independent predictors of functional outcome in patients with AIS and have potential to identify those patients most likely to benefit from reperfusion therapy in the treatment of AIS.

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Prospective Endovascular Treatment in Acute Ischemic Stroke Evaluating Non-Contrast Head CT versus CT Perfusion (PLEASE No CTP)

Interventional Neurology ◽

10.1159/000496615 ◽

2019 ◽

Vol 8 (2-6) ◽

pp. 116-122

Author(s):

Ameer E. Hassan ◽

Hafsah Shamim ◽

Haralabos Zacharatos ◽

Saqib A. Chaudhry ◽

Christina Sanchez ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Ct Perfusion ◽

Treatment Decision ◽

Anterior Circulation ◽

Nihss Score ◽

Contrast Ct

Background: Studies have shown a lack of agreement of computed tomography perfusion (CTP) in the selection of acute ischemic stroke (AIS) patients for endovascular treatment. Purpose: To demonstrate whether non-contrast computed tomography (CT) within 8 h of symptom onset is comparable to CTP imaging. Methods: Prospective study of consecutive anterior circulation AIS patients with a National Institute of Health Stroke Scale (NIHSS) score > 7 presenting within 8 h of symptom onset with endovascular treatment. All patients had non-contrast CT, CT angiography, and CTP. The neuro-interventionalist was blinded to the results of the CTP and based the treatment decision using the Alberta Stroke Program Early CT score (ASPECTS). Baseline demographics, co-morbidities, and baseline NIHSS scores were collected. Outcomes were modified Rankin scale (mRS) score at discharge and in-hospital mortality. Good outcomes were defined as a mRS score of 0–2. Results: 283 AIS patients were screened for the trial, and 119 were enrolled. The remaining patients were excluded for: posterior circulation stroke, no CTP performed, could not obtain consent, and NIHSS score < 7. Mean NIHSS score at admission was 16.8 ± 3, and mean ASPECTS was 8.4 ± 1.4. There was no statistically significant correlation with CTP penumbra and good outcomes: 50 versus 47.8% with no penumbra present (p = 0.85). In patients without evidence of CTP penumbra, there was 22.5% mortality compared to 22.1% mortality in patients with a CTP penumbra. If ASPECTS ≥7, 64.6% had good outcome versus 13.3% if ASPECTS < 7 (p < 0.001). Patients with an ASPECTS ≥7 had 10% mortality versus 51.4% in patients with an ASPECTS < 7 (p < 0.001). Conclusions: CTP penumbra did not identify patients who would benefit from endovascular treatment when patients were selected with non-contrast CT ASPECTS ≥7. There is no correlation of CTP penumbra with good outcomes or mortality. Larger prospective trials are warranted to justify the use of CTP within 6 h of symptom onset.

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Preliminary Application of a Quantitative Collateral Assessment Method in Acute Ischemic Stroke Patients With Endovascular Treatments: A Single-Center Study

Frontiers in Neurology ◽

10.3389/fneur.2021.714313 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ruoyao Cao ◽

Peng Qi ◽

Yun Jiang ◽

Shen Hu ◽

Gengfan Ye ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Collateral Circulation ◽

Ct Perfusion ◽

Infarct Volume ◽

Assessment Method ◽

Outcome Evaluation ◽

Analysis Time ◽

Independent Predictive Factor

Objectives: To develop an efficient and quantitative assessment of collateral circulation on time maximum intensity projection CT angiography (tMIP CTA) in patients with acute ischemic stroke (AIS).Methods: Eighty-one AIS patients who underwent one-stop CTA-CT perfusion (CTP) from February 2016 to October 2020 were retrospectively reviewed. Single-phase CTA (sCTA) and tMIP CTA were developed from CTP data. Ischemic core (IC) volume, ischemic penumbra volume, and mismatch ratio were calculated. The Tan scale was used for the qualitative evaluation of collateral based on sCTA and tMIP CTA. Quantitative collateral circulation (CCq) parameters were calculated semi-automatically with software by the ratio of the vascular volume (V) on both hemispheres, including tMIP CTA VCCq and sCTA VCCq. Spearman correlation analysis was used to analyze the correlation of collateral-related parameters with final infarct volume (FIV). ROC and multivariable regression analysis were calculated to compare the significance of the above parameters in clinical outcome evaluation. The analysis time of the observers was also compared.Results: tMIP CTA VCCq (r = 0.61, p < 0.01), IC volume (r = 0.66, p < 0.01), Tan score on tMIP CTA (r = 0.52, p < 0.01) and mismatch ratio (r = 0.60, p < 0.01) showed moderate negative correlations with FIV. tMIP CTA VCCq showed the best prognostic value for clinical outcome (AUC = 0.93, p < 0.001), and was an independent predictive factor of clinical outcome (OR = 0.14, p = 0.009). There was no difference in analysis time of tMIP CTA VCCq among observers (p = 0.079).Conclusion: The quantitative evaluation of collateral circulation on tMIP CTA is associated with clinical outcomes in AIS patients with endovascular treatments.

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Abstract WMP15: A Simple Tool to Predict Target Mismatch in Ischemic Stroke Patients with Anterior Circulation Occlusion

Stroke ◽

10.1161/str.48.suppl_1.wmp15 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Adam de Havenon ◽

Steve O’Donnell ◽

Alex Linn ◽

Scott McNally ◽

Bailey Dunleavy ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Perfusion Imaging ◽

Time Window ◽

Ct Perfusion ◽

Volumetric Analysis ◽

Stroke Patients ◽

Anterior Circulation ◽

Ct Angiogram

Introduction: The efficacy of endovascular thrombectomy in an extended time window for acute ischemic stroke patients with Target Mismatch (TM) on perfusion imaging was shown in a recent study and the ongoing DEFUSE-3 trial is studying thrombectomy in a 6-16 hour window for TM patients. A limitation of TM is that perfusion imaging is not widely available. We sought to identify a tool to predict TM based on clinical factors and CT angiogram (CTA) imaging, which is available at most hospitals. Methods: We reviewed acute ischemic stroke patients from 2010-2014 with proximal middle cerebral artery occlusion, CTA and CT perfusion (CTP) at hospital admission. TM was identified on CTP using the Olea Sphere volumetric analysis software with Bayesian deconvolution. TM was defined by the DEFUSE-3 criteria. ASPECTS was derived from the non-contrast CT head and the CTA source images (CTA-ASPECTS). Two collateral scores were derived from CTA source images. Results: 61 patients met inclusion criteria. The mean±SD age was 61±18 years and 61% were male. Mean NIH Stroke Scale (NIHSS) was 14.1±8.0 and median (IQR) follow-up modified Rankin Scale was 3 (1,6). TM was present in 35/61 (57%), who had lower mRS at follow-up (z=3.5, p<0.001). The predictor variables are shown in Table 1. The best combination of predictors was CTA-ASPECTS >4 and NIHSS <16, which had a sensitivity of 80% and specificity of 85% for TM (Figure 1). Discussion: We report a reliable, accessible, and clinically useful tool for predicting TM. This score warrants further study as a tool to guide transfer decisions from primary or secondary stroke centers to tertiary centers where endovascular intervention would be possible for selected patients.

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Abstract WP40: “Good” Angiographic Collateral Circulation Correlates With Lower Dwi Infarct Volumes In Acute Ischemic Stroke

Stroke ◽

10.1161/str.44.suppl_1.awp40 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Esteban Cheng-Ching ◽

Dolora Wisco ◽

Shumei Man ◽

Ferdinand Hui ◽

Gabor Toth ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Collateral Circulation ◽

Infarct Volume ◽

Artery Occlusion ◽

Grading System ◽

Large Artery ◽

Anterior Circulation ◽

Vessel Occlusion

Background and purpose Large artery occlusion leads to ischemic stroke which volume is influenced by time from symptom onset. This effect is modulated by several factors, including the presence and degree of collateral circulation. We analyze the correlation between a standard angiographic collateral grading system and DWI infarct volumes. Methods We reviewed a prospectively collected retrospective database of ischemic stroke patients admitted between august of 2006 and december of 2011. We included patients with anterior circulation acute ischemic stroke presenting within 8 hours from symptom onset with large vessel occlusion, who underwent pre-treatment MRI and endovascular therapy. DWI infarct volumes were measured by region of interest. ASITN collateral grading system was used and grouped into “good collaterals” for grades 3 and 4, and “poor collaterals” for grades 0, 1 and 2. JMP statistical software was utilized. Results 152 patients (71 (46.7%) male, mean age: 68±15 years;) were included in the initial analysis. We identified 49 patients who had angiographic collateral circulation grading. Seven patients had ASITN collateral grade 0 with mean infarct volume of 27.6 cc, 25 had collateral grade of 1 with mean infarct volume of 27.9 cc, 10 had collateral grade of 2 with mean infarct volume of 23.4 cc, 5 had collateral grade of 3 with mean infarct volume of 6.3 cc, and 2 had collateral grade of 4 with mean infarct volume of 14.6 cc. Forty two patients had “poor collaterals” with a mean infarct volume of 26.8 cc. Seven patients had “good collaterals” with mean infarct volume of 8.7 cc. When comparing the infarct volumes between these two groups, the difference was statistically significant (p=0.017). Conclusions In anterior circulation acute ischemic stroke, “good” angiographic collateral circulation defined as ASITN grading system of 3 or 4, correlates with lower infarct volumes on presentation.

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Abstract WMP120: Pre-stroke Statin Enhancement of Collateralization in Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wmp120 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mengmeng Ma ◽

Jiaying Zhu ◽

Li He

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Cerebral Artery ◽

Collateral Circulation ◽

Stroke Onset ◽

Stroke Severity ◽

Stroke Patients ◽

Statin Use

Background: Recent studies suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcome in case of stroke onset. It was speculated that pre-stroke statin may enhance collateral circulation and result in favorable functional outcome. This study aimed to investigate the association of pre-stroke statin use with leptomeningeal collaterals in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 hours from May 2011 to April 2017. CTA imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; admission NIHSS was used to measure stroke severity; modified Rankin scale (mRS) at 90 day was used to measure outcome. Univariate and multivariate analyses were performed. Results: 239 patients met inclusion criteria. 54 patients use statin before stroke onset. Pre-stroke statin use was independently associated with good collateral circulations (rLMCS>10) (OR, 4.786; 95% CI, 1.195 - 19.171; P = 0.027). Pre-stroke statin use was not independently associated with lower stroke severity (NIHSS≤14) (OR, 1.955; 95%CI, 0.657- 5.816; P = 0.228), but pre-stroke statin use was independently associated with good outcome (mRS≤2) (OR, 3.868; 95%CI, 1.325 - 11.289; P = 0.013). Conclusion: Pre-stroke statin use seems enhance collateralization and improve clinical outcomes in patients with acute stroke. However, clinical controlled studies should be used to verify this claim.

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