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
. 2024 Jul-Aug;34(4):424-429.
doi: 10.1111/jon.13208. Epub 2024 May 26.

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

Janet Mei  1 , Hamza A Salim  1   2 , Dhairya A Lakhani  1 , Aneri Balar  1 , Basel Musmar  3 , Nimer Adeeb  3 , Meisam Hoseinyazdi  1 , Licia Luna  1 , Francis Deng  1 , Nathan Z Hyson  1 , Adam A Dmytriw  2   4 , Adrien Guenego  5 , Tobias D Faizy  6 , Jeremy J Heit  7 , Gregory W Albers  7 , Victor C Urrutia  1 , Raf Llinas  1 , Elisabeth B Marsh  1 , Argye E Hillis  1 , Kambiz Nael  8 , Vivek S Yedavalli  1
Affiliations

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

Janet Mei et al. J Neuroimaging. 2024 Jul-Aug.

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.

Keywords: AIS‐DMVO; HIR; LAMS; NIHSS; collateral status.

PubMed Disclaimer

References

REFERENCES

    1. Ospel JM, Menon BK, Demchuk AM, et al. Clinical course of acute ischemic stroke due to medium vessel occlusion with and without intravenous alteplase treatment. Stroke. 2020;51:3232‐3240.
    1. Rikhtegar R, Mosimann PJ, Weber R, et al. Effectiveness of very low profile thrombectomy device in primary distal medium vessel occlusion, as rescue therapy after incomplete proximal recanalization or following iatrogenic thromboembolic events. J Neurointerv Surg. 2021;13:1067‐1072.
    1. Wang M, Farouki Y, Hulscher F, et al. Severely hypoperfused brain tissue correlates with final infarct volume despite recanalization in DMVO stroke. J Belg Soc Radiol. 2023;107:90.
    1. Jung S, Gilgen M, Slotboom J, et al. Factors that determine penumbral tissue loss in acute ischaemic stroke. Brain. 2013;136:3554‐3560.
    1. Olivot JM, Mlynash M, Inoue M, et al. Hypoperfusion intensity ratio predicts infarct progression and functional outcome in the DEFUSE 2 Cohort. Stroke. 2014;45:1018‐1023.

Grants and funding