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Leptomeningeal collaterals are associated with modifiable metabolic risk factors
Author(s) -
Me Bijoy K.,
Smith Eric E.,
Coutts Shelagh B.,
Welsh Donald G.,
Faber James E.,
Goyal Mayank,
Hill Michael D.,
Demchuk Andrew M.,
Damani Zaheed,
Cho KyungHee,
Chang HyukWon,
Hong JeongHo,
Sohn Sung Il
Publication year - 2013
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.23906
Subject(s) - medicine , interquartile range , stroke (engine) , hyperuricemia , odds ratio , confidence interval , metabolic syndrome , uric acid , cardiology , obesity , engineering , mechanical engineering
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