Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2016 Oct;58(10):969-977.
doi: 10.1007/s00234-016-1727-5. Epub 2016 Jul 20.

Determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion

Tom van Seeters  1 , Geert Jan Biessels  2 , L Jaap Kappelle  2 , Yolanda van der Graaf  3 , Birgitta K Velthuis  4 ; Dutch acute stroke study (DUST) investigators
Affiliations
Multicenter Study

Determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion

Tom van Seeters et al. Neuroradiology. 2016 Oct.

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: CT angiography; Clinical outcome; Ischemic stroke; Leptomeningeal collateral flow; Stroke etiology.

PubMed Disclaimer

Conflict of interest statement

Compliance with ethical standards We declare that all human studies have been approved by the medical ethics committee of the University Medical Center Utrecht, The Netherlands, and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all participants gave informed consent prior to inclusion in this study; however, the medical ethics committee waived informed consent for patients who died before informed consent could be obtained. Conflict of interest We declare that we have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart depicting the number of patients included in the study
Fig. 2
Fig. 2
Examples of patients with good (A) and poor leptomeningeal collateral flow (B and C), depicted with 20-mm-thick maximum intensity projection (MIP) reconstructions. A Good leptomeningeal collateral flow in a patient with a right-sided ischemic stroke. There was no proximal occlusion and the circle of Willis was complete. The 90-day modified Rankin Scale (mRS) score was 1. B Poor leptomeningeal collateral flow in a patient with a left-sided ischemic stroke and a proximal occlusion in the M1 segment. The 90-day mRS was 6. C Poor leptomeningeal collateral flow in a patient with a right-sided ischemic stroke and an ipsilateral incomplete posterior circle of Willis. The 90-day mRS was also 6
See this image and copyright information in PMC

References

    1. Liebeskind DS. Collateral circulation. Stroke. 2003;34:2279–2284. doi: 10.1161/01.STR.0000086465.41263.06. - DOI - PubMed
    1. van Raamt AF, Mali WP, van Laar PJ, van der Graaf Y. The fetal variant of the circle of Willis and its influence on the cerebral collateral circulation. Cerebrovasc Dis. 2006;22:217–224. doi: 10.1159/000094007. - DOI - PubMed
    1. Kim JJ, Fischbein NJ, Lu Y, Pham D, Dillon WP. Regional angiographic grading system for collateral flow: correlation with cerebral infarction in patients with middle cerebral artery occlusion. Stroke. 2004;35:1340–1344. doi: 10.1161/01.STR.0000126043.83777.3a. - DOI - PubMed
    1. Tan IY, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K, Martin M, Symons SP, Fox AJ, Aviv RI. CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol. 2009;30:525–531. doi: 10.3174/ajnr.A1408. - DOI - PMC - PubMed
    1. Miteff F, Levi CR, Bateman GA, Spratt N, McElduff P, Parsons MW. The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke. Brain. 2009;132:2231–2238. doi: 10.1093/brain/awp155. - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources