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Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes
Author(s) -
Rebello L. C.,
Bouslama M.,
Haussen D. C.,
Grossberg J. A.,
Dehkharghani S.,
Anderson A.,
Belagaje S. R.,
Bianchi N. A.,
Grigoryan M.,
Frankel M. R.,
Nogueira R. G.
Publication year - 2017
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13287
Subject(s) - medicine , collateral circulation , stroke (engine) , cardiology , atrial fibrillation , computed tomography angiography , embolism , angiography , odds ratio , ejection fraction , radiology , perfusion scanning , perfusion , heart failure , mechanical engineering , engineering
Background and purpose Chronic hypoperfusion from athero‐stenotic lesions is thought to lead to better collateral recruitment compared to cardioembolic strokes. It was sought to compare collateral flow in stroke patients with atrial fibrillation ( AF ) versus stroke patients with cervical atherosclerotic steno‐occlusive disease ( CASOD ). Method This was a retrospective review of a prospectively collected endovascular database. Patients with (i) anterior circulation large vessel occlusion stroke, (ii) pre‐treatment computed tomography angiography ( CTA ) and (iii) intracranial embolism from AF or CASOD were included. CTA collateral patterns were evaluated and categorized into two groups: absent/poor collaterals ( CTA collateral score 0–1) versus moderate/good collaterals ( CTA collateral score 2–4). CT perfusion was also utilized for baseline core volume and evaluation of infarct growth. Results A total of 122 patients fitted the inclusion criteria, of whom 88 (72%) had AF and 34 (27%) CASOD . Patients with AF were older ( P < 0.01) and less often males or smokers ( P = 0.04 and P < 0.01 respectively). Baseline National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were comparable between groups. Collateral scores were lower in the AF group ( P = 0.01) with patients having poor collaterals in 28% of cases versus 9% in the CASOD group ( P = 0.03). Mortality rates (20% vs. 0%; P = 0.02) were higher in the AF patients whilst rates of any parenchymal hemorrhage (6% vs. 26%; P < 0.01) were higher in the CASOD group. On multivariable analysis, CASOD was an independent predictor of moderate/good collaterals (odds ratio 4.70; 95% confidence interval 1.17–18.79; P = 0.03). Conclusions Atheroembolic strokes seem to be associated with better collateral flow compared to cardioembolic strokes. This may in part explain the worse outcomes of AF ‐related stroke.