Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada.
Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
Can J Neurol Sci. 2022 Nov;49(6):767-773. doi: 10.1017/cjn.2021.226. Epub 2021 Sep 29.
Collateral status is an indicator of a favorable outcome in stroke. Leptomeningeal collaterals provide alternative routes for brain perfusion following an arterial occlusion or flow-limiting stenosis. Using a large cohort of ischemic stroke patients, we examined the relative contribution of various demographic, laboratory, and clinical variables in explaining variability in collateral status.
Patients with acute ischemic stroke in the anterior circulation were enrolled in a multi-center hospital-based observational study. Intracranial occlusions and collateral status were identified and graded using multiphase computed tomography angiography. Based on the percentage of affected territory filled by collateral supply, collaterals were graded as either poor (0-49%), good (50-99%), or optimal (100%). Between-group differences in demographic, laboratory, and clinical factors were explored using ordinal regression models. Further, we explored the contribution of measured variables in explaining variance in collateral status.
386 patients with collateral status classified as poor ( = 64), good ( = 125), and optimal ( = 197) were included. Median time from symptom onset to CT was 120 (IQR: 78-246) minutes. In final multivariable model, male sex (OR 1.9, 95% CIs [1.2, 2.9], = 0.005) and leukocytosis (OR 1.1, 95% CIs [1.1, 1.2], = 0.001) were associated with poor collaterals. Measured variables only explained 44.8-53.0% of the observed between-patient variance in collaterals.
Male sex and leukocytosis are associated with poorer collaterals. Nearly half of the variance in collateral flow remains unexplained and could be in part due to genetic differences.
侧支循环状态是中风预后的一个指标。软脑膜侧支循环为动脉闭塞或血流受限性狭窄后提供了脑灌注的替代途径。我们使用大量缺血性脑卒中患者的队列，检查了各种人口统计学、实验室和临床变量在解释侧支循环状态变异性方面的相对贡献。
纳入多中心医院观察性研究中的急性前循环缺血性脑卒中患者。使用多相 CT 血管造影术识别和分级颅内闭塞和侧支循环状态。根据侧支供应填充受累区域的百分比，将侧支循环分为差（0-49%）、好（50-99%）或优（100%）。使用有序回归模型探讨组间人口统计学、实验室和临床因素的差异。此外，我们还探讨了测量变量对解释侧支循环状态变异性的贡献。
纳入了 386 例侧支循环状态差（ = 64）、好（ = 125）和优（ = 197）的患者。从症状发作到 CT 的中位时间为 120 分钟（IQR：78-246）。在最终的多变量模型中，男性（比值比 1.9，95%置信区间 [1.2，2.9]， = 0.005）和白细胞增多（比值比 1.1，95%置信区间 [1.1，1.2]， = 0.001）与较差的侧支循环相关。测量变量仅解释了 44.8-53.0%的观察到的患者间侧支循环变异。
男性和白细胞增多与较差的侧支循环相关。近一半的侧支血流变异性仍无法解释，部分原因可能是遗传差异。
