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Isolation and Cannulation of Cerebral Parenchymal Arterioles
Published on: May 23, 2016
The Utility of Collaterals as a Biomarker in Pediatric Unilateral Intracranial Arteriopathy
Jorina Elbers1, Derek Armstrong2, Susanne M Benseler3
1Division of Child Neurology, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Palo Alto, California.
Insights
Lenticulostriate collaterals in children with intracranial arteriopathy may predict distinct vascular outcomes. This neuroimaging biomarker aids in stratifying patients for better prognosis and understanding disease progression.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Vascular Neurology
Background:
- Intracranial arteriopathies are a significant cause of stroke in children and a risk factor for recurrence.
- Vascular imaging is crucial for determining etiology and prognosis in pediatric stroke when tissue diagnosis is unavailable.
- The presence of lenticulostriate collaterals in unilateral intracranial arteriopathy may influence stroke outcomes.
Purpose of the Study:
- To investigate whether children with unilateral intracranial arteriopathy and lenticulostriate collaterals exhibit different vascular outcomes compared to those without.
- To identify potential neuroimaging biomarkers for stratifying pediatric stroke patients.
Main Methods:
- Retrospective identification of children with unilateral intracranial arteriopathy from two institutions.
- Review of baseline and follow-up vascular imaging (MRI/DSA) by blinded raters.
- Comparison of clinical features and vascular imaging outcomes between groups with and without lenticulostriate collaterals using univariate and multivariate analyses.
Main Results:
- Forty-four children were analyzed, divided into collateral (n=20) and non-collateral (n=24) groups.
- Both groups showed similar rates of vascular progression at follow-up (50% vs. 37.5%).
- Collaterals were associated with asymptomatic presentation, normal MRI, border zone infarcts, and stabilization or new contralateral disease, and were an independent predictor of outcome.
Conclusions:
- Lenticulostriate collaterals may serve as a valuable neuroimaging biomarker in pediatric intracranial arteriopathy.
- This biomarker can help stratify patients based on distinct clinical features and vascular evolution patterns.
- Further research can refine the use of collaterals for predicting pediatric stroke outcomes.
Background:
Intracranial arteriopathies are frequent causes of pediatric stroke and important risk factors for stroke recurrence. Without tissue diagnosis, vascular imaging is relied upon to identify the underlying etiology and prognosis. We hypothesized that children with unilateral intracranial arteriopathy with lenticulostriate collaterals would demonstrate distinct vascular outcomes compared with children without collaterals.
Methods:
We retrospectively identified children with unilateral intracranial arteriopathy from two institutions. Two blinded raters from each institution reviewed magnetic resonance or digital subtraction angiography at baseline and ≥12 months. Patients were grouped according to presence or absence of lenticulostriate collaterals. Clinical features and vascular imaging outcomes were compared using univariate analysis and multivariate logistic regression.
Results:
Forty-four children were included: 22 males, median age 8.2 years (range two to 16.9 years), and further stratified into the collateral group (n = 20) and non-collateral group (n = 24), with median follow-up of 25.5 months and 23 months, respectively. Both groups demonstrated similar rates of progression on vascular imaging at ≥12 months, 50% in the collateral group versus 37.5% in the non-collateral group (P > 0.05). The collateral group was associated with asymptomatic clinical presentation, normal brain MRI, border zone infarcts, and either vascular stabilization or new contralateral disease. The non-collateral group demonstrated either vascular improvement or discordant progression (combination of improved and progressive lesions). Using a multivariate model, collaterals continued to be an independent predictor of vascular outcome.
Conclusions:
This study suggests that lenticulostriate collaterals in children with unilateral intracranial arteriopathy may serve as a useful neuroimaging biomarker that helps to stratify patients with distinct clinical features and patterns of vascular evolution.
