Leptomeningeal collaterals are associated with modifiable metabolic risk factors

Bijoy K. Menon, Eric E. Smith, Shelagh B. Coutts, Donald G. Welsh, James E. Faber, Mayank Goyal, Michael D. Hill, Andrew M. Demchuk, Zaheed Damani, Kyung Hee Cho, Hyuk Won Chang, Jeong Ho Hong, Sung Il Sohn

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Abstract

Objective We sought to identify potentially modifiable determinants associated with variability in leptomeningeal collateral status in patients with acute ischemic stroke. Methods Data are from the Keimyung Stroke Registry. Consecutive patients with M1 segment middle cerebral artery ± intracranial internal carotid artery occlusions on baseline computed tomographic angiography (CTA) from May 2004 to July 2009 were included. Baseline and follow-up imaging was analyzed blinded to all clinical information. Two raters assessed leptomeningeal collaterals on baseline CTA by consensus, using a previously validated regional leptomeningeal score (rLMC). Results Baseline characteristics (N = 206) were: mean age = 66.9 ± 11.6 years, median baseline National Institutes of Health Stroke Scale = 14 (interquartile range [IQR] = 11-20), and median time from stroke symptom onset to CTA = 166 minutes (IQR = 96-262). Poor collateral status at baseline (rLMC score = 0-10) was seen in 73 of 206 patients (35.4%). On univariate analyses, patients with poor collateral status at baseline were older; were hypertensive; had higher white blood cell count, blood glucose, D-dimer, and serum uric acid levels; and were more likely to have metabolic syndrome. Multivariate modeling identified metabolic syndrome (odds ratio [OR] = 3.22, 95% confidence interval [CI] = 1.69-6.15, p < 0.001), hyperuricemia (per 1mg/dl serum uric acid; OR = 1.35, 95% CI = 1.12-1.62, p < 0.01), and older age (per 10 years; OR = 1.34, 95% CI = 1.02-1.77, p = 0.03) as independent predictors of poor leptomeningeal collateral status at baseline. Interpretation Metabolic syndrome, hyperuricemia, and age are associated with poor leptomeningeal collateral status in patients with acute ischemic stroke.

Original languageEnglish
Pages (from-to)241-248
Number of pages8
JournalAnnals of Neurology
Volume74
Issue number2
DOIs
Publication statusPublished - 2013 Aug 1

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    Menon, B. K., Smith, E. E., Coutts, S. B., Welsh, D. G., Faber, J. E., Goyal, M., Hill, M. D., Demchuk, A. M., Damani, Z., Cho, K. H., Chang, H. W., Hong, J. H., & Sohn, S. I. (2013). Leptomeningeal collaterals are associated with modifiable metabolic risk factors. Annals of Neurology, 74(2), 241-248. https://doi.org/10.1002/ana.23906