Abstract T P39: Leptomeningeal Collaterals in Patients with Proximal Middle Cerebral Artery Occlusion are Associated with Milder Stroke and Better Functional Outcome after Fibrinolysis
Background: Proximal middle cerebral artery occlusions (M1 occlusion) are often but not always associated with severe stroke and poor outcome. The presence of leptomeningeal collaterals can potentially reduce the acute ischemia and thus reduce stroke severity. Occlusions and collaterals can be assessed using computed tomography angiography (CTA). Collaterals were scored according to the amount of collateral supply filling the occluded middle cerebral artery territory. We assessed the hypothesis that leptomeningeal collaterals covariates with National Institutes of Health Stroke Scale (NIHSS) at time of admission and with three month outcome after acute ischaemic stroke.
Method: Fifty-eight patients - subsequently diagnosed with a M1 occlusion on CTA - were admitted within 4.5 hours after symptom onset between May 2009 and December 2011. All patients were scored according to NIHSS at time of admittance by a stroke-neurologist. Occlusions and leptomeningeal collaterals were evaluated on the nonenhanced CT and CTA. All patients received fibrinolysis. Outcome was assessed by modified Rankin Scale (mRS) at 3 months.
Results: Fifty-eight patients with a M1 occlusion were included into the analysis (57% female, 43% male, mean age 70 years, range 42-93 years). There was no correlation between age and collateral score. Median NIHSS at time of admittance was 15 (range 3-25), which correlated to the collateral score (r= -0.422, p=0.001). Median mRS at 3 months was 3 (range 0-6) and a correlation with the collateral score was present (r=-0.361, p=0.007).
Conclusion: Leptomeningeal collaterals on CT angiography in patients with a proximal middle cerebral artery occlusion relate to lower NIHSS on admission as well as less handicap three months after fibrinolysis treatment.
Author Disclosures: C.R. Trampedach: None. C. Ovesen: None. A.F. Christensen: None. H.K. Christensen: Employment; Modest; Associate Research Professor with the Capitol Region of Denmark.
- © 2014 by American Heart Association, Inc.