Adam de Havenon, MD1; David R. Haynor, MD, PhD2; David L. Tirschwell, MD, MSc3; et al Jennifer J. Majersik, MD, MS1; Gordon Smith, MD1; Wendy Cohen, MD2; Jalal B. Andre, MD2
JAMA Neurol. Published online February 13, 2017. doi:10.1001/jamaneurol.2016.4491
Findings In a cohort study of 38 patients with acute ischemic stroke, collaterals on arterial spin labeling were associated with better neurologic outcome at hospital discharge, both in unadjusted and adjusted analyses.
Meaning This novel association between arterial spin labeling MRI collaterals and improved neurologic outcome may help guide prognosis and management, particularly in patients who are unable to undergo contrast-based radiological studies.
Objective To assess the association between the presence of collateral vessels identified using arterial spin labeling (ASL) magnetic resonance imaging, a technique that does not require exogenous administration of contrast, and neurologic outcome in patients after AIS.
Design, Setting, and Participants This retrospective cohort study examined 38 patients after AIS admitted to a tertiary academic medical center between 2012 and 2014 who underwent MRI with ASL.
Main Outcomes and Measures According to a prespecified hypothesis, ASL images were graded for the presence of collaterals by 2 neuroradiologists. Modified Rankin Scale (mRS) scores at discharge and other composite data were abstracted from the medical record by a neurologist blinded to radiologic data.
Results Of the 38 patients, 19 (50.0%) were male, and the mean (SD) age was 61 (20) years. In 25 of 38 patients (65.8%), collaterals were detected using ASL, which were significantly associated with both a good outcome (mRS score of 0-2 at discharge; P = .02) and a 1-point decrease in mRS score at discharge (odds ratio, 6.4; 95% CI, 1.7-23.4; P = .005). In a multivariable ordinal logistic regression model, controlling for admission National Institutes of Health Stroke Scale score, history of atrial fibrillation, premorbid mRS score, and stroke parent artery status, there was a strong association between the presence of ASL collaterals and a 1-point decrease in the mRS score at discharge (odds ratio, 5.1; 95% CI, 1.2-22.1; P = .03).
Conclusions and Relevance Following AIS, the presence of ASL collaterals is strongly associated with better neurological outcome at hospital discharge. This novel association between ASL collaterals and improved neurologic outcome may help guide prognosis and management, particularly in patients who are unable to undergo contrast-based radiological studies.