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Collaterals dramatically alter stroke risk in intracranial atherosclerosis

David S Liebeskind1, George A Cotsonis, Jeffrey L Saver

  • 1UCLA Stroke Center, Los Angeles, CA 90095, USA. davidliebeskind@yahoo.com

Annals of Neurology
|March 26, 2011
PubMed

Insights

Collateral circulation significantly impacts stroke risk in intracranial atherosclerosis. Good collaterals protect against stroke in severe stenosis, while poor collaterals indicate higher risk in milder stenosis.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Radiology

Background:

  • Intracranial atherosclerosis is a major cause of stroke.
  • The degree of arterial stenosis correlates with stroke risk.
  • The role of collateral circulation in modifying this risk is not well understood.

Purpose of the Study:

  • To investigate the role of collateral circulation in modifying stroke risk in patients with intracranial atherosclerosis.
  • To assess the impact of collaterals on subsequent stroke characteristics.

Main Methods:

  • Collateral flow was graded from baseline angiograms in 287 patients from the Warfarin--Aspirin Symptomatic Intracranial Disease (WASID) trial.
  • Patients had stenoses ranging from 50-99% and adequate collateral views.
  • Statistical models predicted stroke risk based on collateral grade, stenosis percentage, and other covariates.

Main Results:

  • Collateral extent predicted stroke risk across all stenoses (P < 0.0001).
  • Extensive collaterals reduced stroke risk in severe stenoses (70-99%, P = 0.0427).
  • Collaterals were associated with increased stroke likelihood in milder stenoses (50-69%, P < 0.0001).

Conclusions:

  • Collateral circulation is a critical factor in determining stroke risk in intracranial atherosclerosis.
  • Collaterals offer protection in severe stenoses but may indicate instability in milder stenoses.
Abstract

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