Impact of collateral flow on tissue fate in acute ischaemic stroke

作者：Oh Young Bang, Jeffrey L. Saver, Brian H Buck, Jeffry R. Alger, Sidney J. Starkman, Bruce Ovbiagele, D Kim, Reza Jahan, Gary Duckwiler, Sa Rah Yoon, Fernando Viñuela, David S. Liebeskind, for the UCLA Collateral Investigators · 发表于：Journal of Neurology Neurosurgery & Psychiatry · 年份：2007 · DOI：10.1136/jnnp.2007.132100 · 被引用次数：383 · 研究领域：Acute Ischemic Stroke Management、Advanced MRI Techniques and Applications、MRI in cancer diagnosis

BACKGROUND: Collaterals may sustain penumbra prior to recanalisation yet the influence of baseline collateral flow on infarct growth following endovascular therapy remains unknown. METHODS: Consecutive patients underwent serial diffusion and perfusion MRI before and after endovascular therapy for acute cerebral ischaemia. We assessed the relationship between MRI diffusion and perfusion lesion indices, angiographic collateral grade and infarct growth. Tmax perfusion lesion maps were generated and diffusion-perfusion mismatch regions were divided into Tmax >or=4 s (severe delay) and Tmax >or=2 but <4 s (mild delay). RESULTS: Among 44 patients, collateral grade was poor in 7 (15.9%), intermediate in 20 (45.5%) and good in 17 (38.6%) patients. Although diffusion-perfusion mismatch volume was not different depending on the collateral grade, patients with good collaterals had larger areas of milder perfusion delay than those with poor collaterals (p = 0.005). Among 32 patients who underwent day 3-5 post-treatment MRIs, the degree of pretreatment collateral circulation (r = -0.476, p = 0.006) and volume of diffusion-perfusion mismatch (r = 0.371, p = 0.037) were correlated with infarct growth. Greatest infarct growth occurred in patients with both non-recanalisation and poor collaterals. Multiple regression analysis revealed that pretreatment collateral grade was independently associated with infarct growth. CONCLUSION: Our data suggest that angiographic collateral grade and penumbr...