Lower admission stroke severity is associated with good collateral status in distal medium vessel occlusion stroke

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY Journal of Neuroimaging Pub Date : 2024-05-26 DOI:10.1111/jon.13208

Janet Mei, Hamza A. Salim, Dhairya A. Lakhani, Aneri Balar, Basel Musmar, Nimer Adeeb, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z. Hyson, Adam A. Dmytriw, Adrien Guenego, Tobias D. Faizy, Jeremy J. Heit, Gregory W. Albers, Victor C. Urrutia, Raf Llinas, Elisabeth B. Marsh, Argye E. Hillis, Kambiz Nael, Vivek S. Yedavalli

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Abstract

Background and Purpose

Distal medium vessel occlusions (DMVOs) are a significant contributor to acute ischemic stroke (AIS), with collateral status (CS) playing a pivotal role in modulating ischemic damage progression. We aimed to explore baseline characteristics associated with CS in AIS-DMVO.

Methods

This retrospective analysis of a prospectively collected database enrolled 130 AIS-DMVO patients from two comprehensive stroke centers. Baseline characteristics, including patient demographics, admission National Institutes of Health Stroke Scale (NIHSS) score, admission Los Angeles Motor Scale (LAMS) score, and co-morbidities, including hypertension, hyperlipidemia, diabetes, coronary artery disease, atrial fibrillation, and history of transient ischemic attack or stroke, were collected. The analysis was dichotomized to good CS, reflected by hypoperfusion index ratio (HIR) <.3, versus poor CS, reflected by HIR ≥.3.

Results

Good CS was observed in 34% of the patients. As to the occluded location, 43.8% occurred in proximal M2, 16.9% in mid M2, 35.4% in more distal middle cerebral artery, and 3.8% in distal anterior cerebral artery. In multivariate logistic analysis, a lower NIHSS score and a lower LAMS score were both independently associated with a good CS (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.82-0.95, p < .001 and OR: 0.77, 95% CI: 0.62-0.96, p = .018, respectively). Patients with poor CS were more likely to manifest as moderate to severe stroke (29.1% vs. 4.5%, p < .001), while patients with good CS had a significantly higher chance of having a minor stroke clinically (40.9% vs. 12.8%, p < .001).

Conclusions

CS remains an important determinant in the severity of AIS-DMVO. Collateral enhancement strategies may be a worthwhile pursuit in AIS-DMVO patients with more severe initial stroke presentation, which can be swiftly identified by the concise LAMS and serves as a proxy for underlying poor CS.

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在远端中血管闭塞性卒中中，较低的入院卒中严重程度与良好的侧支状态相关。

背景和目的：远端中血管闭塞（DMVO）是急性缺血性卒中（AIS）的重要诱因，而侧支状态（CS）在调节缺血性损伤进展中起着关键作用。我们旨在探讨与 AIS-DMVO 中 CS 相关的基线特征：本研究对前瞻性收集的数据库进行了回顾性分析，纳入了来自两家综合卒中中心的 130 名 AIS-DMVO 患者。收集了基线特征，包括患者人口统计学特征、入院时美国国立卫生研究院卒中量表（NIHSS）评分、入院时洛杉矶运动量表（LAMS）评分以及合并疾病，包括高血压、高脂血症、糖尿病、冠心病、心房颤动以及短暂性脑缺血发作或卒中病史。分析结果以低灌注指数比值（HIR）反映的良好 CS 为二分法：34%的患者CS良好。就闭塞位置而言，43.8%发生在M2近端，16.9%发生在M2中段，35.4%发生在更远端大脑中动脉，3.8%发生在远端大脑前动脉。在多变量逻辑分析中，较低的 NIHSS 评分和较低的 LAMS 评分均与良好的 CS 独立相关（比值比 [OR]：0.88，95% 置信区间 [CI]：0.82-0.95, p 结论：CS仍是决定AIS-DMVO严重程度的重要因素。对于初始卒中表现较严重的 AIS-DMVO 患者，侧支增强策略可能是一个值得追求的目标，简明的 LAMS 可以迅速识别侧支增强策略，并可作为潜在不良 CS 的替代指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuroimaging 医学-核医学

CiteScore

4.70

自引率

0.00%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!