Collateral circulation on perfusion-computed tomography-source images predicts the response to stroke intravenous thrombolysis
Version of Record online: 24 DEC 2012
© 2012 The Author(s) European Journal of Neurology © 2012 EFNS
European Journal of Neurology
Volume 20, Issue 5, pages 795–802, May 2013
How to Cite
Calleja, A. I., Cortijo, E., García-Bermejo, P., Gómez, R. D., Pérez-Fernández, S., del Monte, J. M., Muñoz, M. F., Fernández-Herranz, R. and Arenillas, J. F. (2013), Collateral circulation on perfusion-computed tomography-source images predicts the response to stroke intravenous thrombolysis. European Journal of Neurology, 20: 795–802. doi: 10.1111/ene.12063
- Issue online: 11 APR 2013
- Version of Record online: 24 DEC 2012
- Manuscript Accepted: 1 NOV 2012
- Manuscript Received: 4 APR 2012
Background and purpose
Perfusion-computed tomography-source images (PCT-SI) may allow a dynamic assessment of leptomeningeal collateral arteries (LMC) filling and emptying in middle cerebral artery (MCA) ischaemic stroke. We described a regional LMC scale on PCT-SI and hypothesized that a higher collateral score would predict a better response to intravenous (iv) thrombolysis.
We studied consecutive ischaemic stroke patients with an acute MCA occlusion documented by transcranial Doppler/transcranial color-coded duplex, treated with iv thrombolysis who underwent PCT prior to treatment. Readers evaluated PCT-SI in a blinded fashion to assess LMC within the hypoperfused MCA territory. LMC scored as follows: 0, absence of vessels; 1, collateral supply filling ≤ 50%; 2, between> 50% and < 100%; 3, equal or more prominent when compared with the unaffected hemisphere. The scale was divided into good (scores 2–3) vs. poor (scores 0–1) collaterals. The predetermined primary end-point was a good 3-month functional outcome, while early neurological recovery, transcranial duplex-assessed 24-h MCA recanalization, 24-h hypodensity volume and hemorrhagic transformation were considered secondary end-points.
Fifty-four patients were included (55.5% women, median NIHSS 10), and 4-13-23-14 patients had LMC score (LMCs) of 0-1-2-3, respectively. The probability of a good long-term outcome augmented gradually with increasing LMCs: (0) 0%; (1) 15.4%; (2) 65.2%; (3) 64.3%, P = 0.004. Good-LMCs was independently associated with a good outcome [OR 21.02 (95% CI 2.23–197.75), P = 0.008]. Patients with good LMCs had better early neurological recovery (P = 0.001), smaller hypodensity volumes (P < 0.001) and a clear trend towards a higher recanalization rate.
A higher degree of LMC assessed by PCT-SI predicts good response to iv thrombolysis in MCA ischaemic stroke patients.