Leptomeningeal Collateral Status in Patients with Acute Ischemic Stroke: Determinants and Relationship with Clinical Outcome

Abstract

Objectives Identify determinants associated with variability in collateral status in patients with acute ischemic stroke and test if collateral status on CTA can be used to select patients for intra-arterial therapy (IAT). Methods Data are from the Keimyung Stroke Registry. Patients with M1 MCA occlusion on baseline CTA from 5/2004 to 7/2009 were included. All imaging was analyzed blinded to clinical information. Results Multivariable modeling identified metabolic syndrome (OR 3.22 95% CI 1.69-6.15, p<0.001), hyperuricemia (per 1 mg/dl OR 1.35 95% CI 1.12-1.62, p<0.01) and older age (per 10 years, OR 1.34 95% CI 1.02-1.77, p=0.03) as independent predictors of poor collateral status. Only patients with intermediate or good collaterals who recanalize show association with good clinical outcome. (Rate Ratio=3.8, 95% CI 1.2-12.1). Conclusions Metabolic syndrome, hyperuricemia and age are associated with poor collateral status. Patients with poor collaterals on CTA do not benefit from IAT.