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Association of Collateral Status and Ischemic Core Growth in Patients With Acute Ischemic Stroke

Longting Lin1, Jianhong Yang1, Chushuang Chen1

  • 1From the Department of Neurology (L.L., J.Y.), Ningbo First Hospital, China; School of Medicine and Public Health (L.L., C.C., H.T., N.J.S., C.R.L., M.W.P.), University of Newcastle; Melbourne Brain Centre at Royal Melbourne Hospital (A.B., M.W.P.), University of Melbourne; and The Sydney Partnership for Health, Education, Research and Enterprise (C.R.L.), Australia.

Neurology
|December 2, 2020
PubMed

Insights

Patients with acute ischemic stroke and poor collateral circulation experience faster ischemic core growth. This study quantifies how collateral status directly impacts the rate of core growth in stroke patients.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Research

Background:

  • Acute ischemic stroke is a leading cause of disability.
  • Effective management hinges on understanding factors influencing infarct progression.
  • Collateral circulation plays a critical role in determining stroke outcomes.

Purpose of the Study:

  • To investigate the relationship between collateral status and ischemic core growth rate in acute ischemic stroke.
  • To validate the predictive power of collateral status on core growth.

Main Methods:

  • Two cohorts (derivation and validation) of acute ischemic stroke patients with large vessel occlusion were analyzed.
  • Core growth rate was calculated using CT perfusion (CTP) data.
  • Collateral status was assessed using the CTP collateral index, categorized into tertiles.

Main Results:

  • Patients with poor collateral status (tertile 3) exhibited significantly faster median core growth rates (25.41 mL/h) compared to moderate (8.65 mL/h) and good collateral status (2.93 mL/h).
  • A 1% increase in the collateral index was associated with a 0.57 mL/h increase in core growth rate in cohort 1 and 0.59 mL/h in cohort 2.
  • These findings were consistent across both study cohorts, confirming the predictive value of the collateral index.

Conclusions:

  • Collateral status is a significant determinant of ischemic core growth in acute ischemic stroke.
  • The CTP collateral index effectively predicts the rate of infarct expansion.
  • Understanding collateral status is crucial for optimizing treatment strategies in stroke patients.
Abstract

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