Leptomeningeal collaterals are associated with modifiable metabolic risk factors

Authors

  • Bijoy K. Menon MD,

    1. Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
    2. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
    3. Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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  • Eric E. Smith MD, MPH,

    1. Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
    2. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
    3. Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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  • Shelagh B. Coutts BSc, MD,

    1. Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
    2. Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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  • Donald G. Welsh PhD,

    1. Department of Physiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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  • James E. Faber PhD,

    1. Department of Cell and Molecular Physiology, University of North Carolina, Chapel Hill, NC
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  • Mayank Goyal MD,

    1. Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
    2. Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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  • Michael D. Hill MD, MSc,

    1. Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
    2. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
    3. Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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  • Andrew M. Demchuk MD,

    1. Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
    2. Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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  • Zaheed Damani MSc,

    1. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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  • Kyung-Hee Cho MD, PhD,

    1. Department of Neurology, Korea University College of Medicine, Seoul, South Korea
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  • Hyuk-Won Chang MD,

    1. Departments of Radiology, Keimyung University, Daegu, South Korea
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  • Jeong-Ho Hong MD,

    1. Neurology, Dongsan Medical Center, Keimyung University, Daegu, South Korea
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  • Sung Il Sohn MD, PhD

    Corresponding author
    • Neurology, Dongsan Medical Center, Keimyung University, Daegu, South Korea
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Address correspondence to Dr Sohn, Department of Neurology, Dongsan Medical Center, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, South Korea. E-mail: sungil.sohn@gmail.com

Abstract

Objective

We sought to identify potentially modifiable determinants associated with variability in leptomeningeal collateral status in patients with acute ischemic stroke.

Methods

Data are from the Keimyung Stroke Registry. Consecutive patients with M1 segment middle cerebral artery ± intracranial internal carotid artery occlusions on baseline computed tomographic angiography (CTA) from May 2004 to July 2009 were included. Baseline and follow-up imaging was analyzed blinded to all clinical information. Two raters assessed leptomeningeal collaterals on baseline CTA by consensus, using a previously validated regional leptomeningeal score (rLMC).

Results

Baseline characteristics (N = 206) were: mean age = 66.9 ± 11.6 years, median baseline National Institutes of Health Stroke Scale = 14 (interquartile range [IQR] = 11–20), and median time from stroke symptom onset to CTA = 166 minutes (IQR = 96–262). Poor collateral status at baseline (rLMC score = 0–10) was seen in 73 of 206 patients (35.4%). On univariate analyses, patients with poor collateral status at baseline were older; were hypertensive; had higher white blood cell count, blood glucose, D-dimer, and serum uric acid levels; and were more likely to have metabolic syndrome. Multivariate modeling identified metabolic syndrome (odds ratio [OR] = 3.22, 95% confidence interval [CI] = 1.69–6.15, p < 0.001), hyperuricemia (per 1mg/dl serum uric acid; OR = 1.35, 95% CI = 1.12–1.62, p < 0.01), and older age (per 10 years; OR = 1.34, 95% CI = 1.02–1.77, p = 0.03) as independent predictors of poor leptomeningeal collateral status at baseline.

Interpretation

Metabolic syndrome, hyperuricemia, and age are associated with poor leptomeningeal collateral status in patients with acute ischemic stroke. Ann Neurol 2013;74:241–248

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