Differential Benefit of Collaterals for Stroke Patients Treated with Thrombolysis or Supportive Care
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ORIGINAL ARTICLE
Differential Benefit of Collaterals for Stroke Patients Treated with Thrombolysis or Supportive Care A Propensity Score Matched Analysis Felix Schuler1 · Lukas T. Rotkopf1 · Daniel Apel1 · Matthias P. Fabritius1 · Steffen Tiedt2 · Frank A. Wollenweber2 · Lars Kellert3 · Franziska Dorn4 · Thomas Liebig4 · Kolja M. Thierfelder5 · Wolfgang G. Kunz1 Received: 3 May 2019 / Accepted: 5 July 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose Leptomeningeal collaterals can slow down infarction growth; however, despite good collaterals in the DAWN and DEFUSE 3 trials, outcomes were devastating if reperfusion was not attempted. The aim of this study was to compare the influence of collaterals on morphological and functional outcome in patients with acute middle cerebral artery (MCA) stroke undergoing intravenous thrombolysis (IVT) vs. supportive care (non-IVT). Methods Out of 1639 consecutive patients examined with multiparametric computed tomography (CT) for suspected ischemic stroke, all patients with confirmed MCA stroke who did not undergo endovascular thrombectomy were selected. Propensity score matching (PSM) was used to match IVT and non-IVT treated patients for potential confounders including age, sex, National Institutes of Health Stroke Scale (NIHSS) score on admission, Alberta Stroke Program Early CT Score (ASPECTS), and occlusion site. Regression analysis after PSM was performed to identify independent associations. Results After PSM, 90 IVT patients were matched with 90 non-IVT patients. In multivariable regression analysis, a high regional leptomeningeal collateral (rLMC) score was independently associated with lower final infarction volume (FIV) in the IVT group (b = –0.472, p < 0.001) but not in the non-IVT group (b = –0.116, p = 0.327). The trichotomized rLMC scores predicted functional outcome in IVT treated patients (adjusted odds ratio, aOR = 4.57, 95% confidence interval, CI, 1.03–20.32, p = 0.046) but showed no independent association with outcome in the non-IVT group (aOR = 0.69, 95% CI 0.07–6.80, p = 0.753). Conclusion Good collaterals favored smaller FIV and good functional outcome in IVT treated patients but not in non-IVT treated patients. Good collateral flow may have limited prognostic value if IVT is not administered to attempt reperfusion
Keywords IVT · Ischemia · CBV · CT perfusion · Cerebral circulation
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00062-019-00815-y) contains supplementary material, which is available to authorized users. Felix Schuler
2
Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
3
Department of Neurology, University Hospital, LMU Munich, Munich, Germany
4
Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Munich, Germany
5
Institute for Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
[email protected] 1
Department of Radiology,
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