Association between Early Ischemic Changes and Collaterals in Acute Stroke: A Retrospective Study

Area of Science:

• Neurology
• Radiology
• Stroke Imaging

Background:

• Leptomeningeal collaterals play a crucial role in acute stroke, potentially affecting infarct progression speed.
• Assessing collateral status is vital for understanding stroke pathophysiology and guiding treatment.
• The interplay between collateral quality, time, and ischemic changes requires further investigation.

Purpose of the Study:

• To evaluate the association between leptomeningeal collateral score and ischemic changes on CT.
• To investigate the interaction of collateral status and time with the Alberta Stroke Program Early CT Score (ASPECTS).

Main Methods:

• Adult patients with anterior circulation large-vessel occlusion and acute stroke symptoms were included.
• Non-contrast CT (NCCT) and multiphase CT angiography (CTA) were reviewed to assess ASPECTS and leptomeningeal collateral scores.
• Multivariate regression models and receiver operating characteristic (ROC) curve analysis were employed.

Main Results:

• Leptomeningeal collateral scores of 0-1 were associated with lower ASPECTS.
• A significant multiplicative interaction was observed between time and leptomeningeal collateral score on ASPECTS.
• The negative predictive value for poor ASPECTS was high (>0.9) within the first 3 hours for patients with poor collaterals.

Conclusions:

• Poor leptomeningeal collateral scores (0-1) are linked to lower ASPECTS in acute stroke.
• Time has a significant multiplicative interaction with leptomeningeal collateral score in determining ASPECTS.
• These findings highlight the importance of collateral status in acute stroke imaging assessment.