How temporal evolution of intracranial collaterals in acute stroke affects clinical outcomes
| Autor: | Adrian F. Low, Leonard L.L. Yeo, Raymond C.S. Seet, Aftab Ahmad, Vivek Sharma, Rahul Rathakrishnan, Mahendran Nadarajah, Edgar Lik Wui Tay, Anil Gopinathan, Prakash R Paliwal, Narayanaswamy Venketasubramanian, Derek Soon, Bernard P.L. Chan, Hock Luen Teoh, Eric Ting |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Collateral Collateral Circulation Tissue plasminogen activator Article 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Text mining Modified Rankin Scale Internal medicine medicine Humans Mortality Aged Retrospective Studies Acute stroke Aged 80 and over business.industry Retrospective cohort study Middle Aged Collateral circulation Surgery Stroke Treatment Outcome Cerebrovascular Circulation Tissue Plasminogen Activator Cohort Cardiology Female Neurology (clinical) Tomography X-Ray Computed business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Neurology. 86:434-441 |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/wnl.0000000000002331 |
| Popis: | Objective: We compared intracranial collaterals on pretreatment and day 2 brain CT angiograms (CTA) to assess their evolution and relationship with functional outcomes in acute ischemic stroke (AIS) patients treated with IV tissue plasminogen activator (tPA). Methods: Consecutive AIS patients who underwent pretreatment and day 2 CTA and received IV tPA during 2010–2013 were included. Collaterals were evaluated by 2 independent neuroradiologists using 3 predefined criteria: the Miteff system, the Maas system, and 20-point collateral scale by the Alberta Stroke Program Early CT Score methodology. We stratified our cohort by baseline pre-tPA state of their collaterals and by recanalization status of the primary vessel for analysis. Good outcomes at 3 months were defined by a modified Rankin Scale score of 0–1. Results: This study included 209 patients. Delayed collateral recruitment by any grading system was not associated with good outcomes. All 3 scoring systems showed that collateral recruitment on the follow-up CTA from a baseline poor collateral state was significantly associated with poor outcome and increased bleeding risk. When the primary vessel remained persistently occluded, collateral recruitment was significantly associated with worse outcomes. Interestingly, collateral recruitment was significantly associated with increased mortality in 2 of the 3 grading systems. Conclusions: Not all collateral recruitment is beneficial; delayed collateral recruitment may be different from early recruitment and can result in worse outcomes and higher mortality. Prethrombolysis collateral status and recanalization are determinants of how intracranial collateral evolution affects functional outcomes. |
| Databáze: | OpenAIRE |
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