van Seeters Tom, Biessels Geert Jan, Kappelle L Jaap, van der Graaf Yolanda, Velthuis Birgitta K
Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01 132, 3584 CX, Utrecht, The Netherlands.
Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
Neuroradiology. 2016 Oct;58(10):969-977. doi: 10.1007/s00234-016-1727-5. Epub 2016 Jul 20.
Poor leptomeningeal collateral flow is related to worse clinical outcome in acute ischemic stroke, but the factors that determine leptomeningeal collateral patency are largely unknown. We explored the determinants of leptomeningeal collateral flow and assessed their effect on the relation between leptomeningeal collateral flow and clinical outcome.
We included 484 patients from the Dutch acute stroke study (DUST) with a middle cerebral artery (MCA) occlusion. The determinants of poor leptomeningeal collateral flow (≤50 % collateral filling) were identified with logistic regression. We calculated the relative risk (RR) of poor leptomeningeal collateral flow in relation to poor clinical outcome (90-day modified Rankin Scale 3-6) using Poisson regression and assessed whether the determinants of leptomeningeal collateral flow affected this relation.
Leptomeningeal collateral flow was poor in 142 patients (29 %). In multivariable analyses, higher admission glucose level (odds ratio (OR) 1.1 per mmol/L increase (95 % CI 1.0-1.2)), a proximal MCA occlusion (OR 1.9 (95 % CI 1.3-3.0)), and an incomplete posterior circle of Willis (OR 1.7 (95 % CI 1.1-2.6)) were independently related to poor leptomeningeal collateral flow. Poor leptomeningeal collateral flow was related to poor clinical outcome (unadjusted RR 1.7 (95 % CI 1.4-2.0)), and this relation was not affected by the determinants of leptomeningeal collateral flow.
Our study shows that admission glucose level, a proximal MCA occlusion, and an incomplete ipsilateral posterior circle of Willis are determinants of leptomeningeal collateral flow that represent a combination of congenital, acquired, and acute factors. After adjustment for these determinants, leptomeningeal collateral flow remains related to clinical outcome.
软脑膜侧支血流不佳与急性缺血性卒中的临床预后较差相关，但决定软脑膜侧支通畅性的因素在很大程度上尚不清楚。我们探讨了软脑膜侧支血流的决定因素，并评估了它们对软脑膜侧支血流与临床预后之间关系的影响。
我们纳入了荷兰急性卒中研究（DUST）中484例大脑中动脉（MCA）闭塞的患者。通过逻辑回归确定软脑膜侧支血流不佳（侧支充盈≤50%）的决定因素。我们使用泊松回归计算软脑膜侧支血流不佳与不良临床预后（90天改良Rankin量表评分3 - 6分）相关的相对风险（RR），并评估软脑膜侧支血流的决定因素是否影响这种关系。
142例患者（29%）软脑膜侧支血流不佳。在多变量分析中，入院血糖水平较高（每增加1 mmol/L，优势比（OR）为1.1（95%置信区间1.0 - 1.2））、MCA近端闭塞（OR为1.9（95%置信区间1.3 - 3.0））以及Willis后循环不完整（OR为1.7（95%置信区间1.1 - 2.6））与软脑膜侧支血流不佳独立相关。软脑膜侧支血流不佳与不良临床预后相关（未调整的RR为1.7（95%置信区间1.4 - 2.0）），并且这种关系不受软脑膜侧支血流决定因素的影响。
我们的研究表明，入院血糖水平、MCA近端闭塞以及同侧Willis后循环不完整是软脑膜侧支血流的决定因素，它们代表了先天性、后天性和急性因素的组合。在对这些决定因素进行调整后，软脑膜侧支血流仍与临床预后相关。
