http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2012.00922.x/abstract;jsessionid=64AF10A8E750D042FE3C30B89DE55D6E.d02t02
Background
In stroke patients, collateral flow can rapidly be assessed on computed tomography angiography (CTA).
Aims
In
this study, the impact of baseline collaterals on early outcome and
risk of symptomatic intracerebral hemorrhages after systemic
thrombolysis in patients with proximal arterial occlusions within the
anterior circulation were analyzed.
Methods
Collateralization
scores were determined on the CT angiography source images (0 = absent;
1 ≤ 50%, 2 greater than 50% but less than 100%, and 3 = 100% collateral filling) of
patients with distal intracranial carotid artery and/or M1 segment
occlusions treated from 2008 to December 2011. A collateral score of 0
to 1 was designated as poor and 2 to 3 as good collateral vessel status.
Outcome variables included in hospital mortality, favorable outcome at
discharge (modified Rankin score ≤ 2), and rates of symptomatic
intracerebral hemorrhage based on the European–Australasian Acute Stroke
Study II definition.
Results
Among
246 subjects (mean age of 74 years; median National Institutes of
Health Stroke Scale N at admission 14), 205 patients (83%) had good
collaterals, whereas 41 patients (17%) had poor collaterals,
respectively. Patients with poor collaterals had significantly higher
rates of in-hospital mortality (41% vs. 12%, P less than 0·001), of symptomatic intracerebral hemorrhage (15% vs. 4·9%, P less than 0·05) and had significantly lower rates of favorable early clinical outcome (0% vs. 28%, P less than 0·001) compared with those with good collaterals. The grade of
collateralization was independently associated with in-hospital
mortality (P less than 0·001), early clinical outcome (P less than 0·01), and rates of symptomatic intracerebral hemorrhage (P less than 0·01).
Conclusion
Patients
with proximal arterial occlusions within the anterior circulation and
poor baseline collaterals have a poor early functional outcome and high
rates of symptomatic intracerebral hemorrhage after systemic
thrombolysis. Since similar findings have also been reported after
endovascular therapy, strategies to improve collateral blood flow should
be assessed in this patient population.
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