| Author |
Ichijo, M. Iwasawa, E. Numasawa, Y. Miki, K. Ishibashi, S. Tomita, M. Tomimitsu, H. Kamata, T. Fujigasaki, H. Shintani, S. Mizusawa, H. |
| Description |
Country affiliation: Japan Author Affiliation: Ichijo M ( From the Department of Neurology and Neurological Science (M.I., E.I., Y.N., S.I., and H.M.) Department of Neurology, Musashino Red Cross Hospital (M.I., T.K.), Tokyo, Japan.); Iwasawa E ( From the Department of Neurology and Neurological Science (M.I., E.I., Y.N., S.I., and H.M.).); Numasawa Y ( From the Department of Neurology and Neurological Science (M.I., E.I., Y.N., S.I., and H.M.).); Miki K ( Department of Endovascular Surgery (K.M.).); Ishibashi S ( From the Department of Neurology and Neurological Science (M.I., E.I., Y.N., S.I., and H.M.) t-ishibashi.nuro@tmd.ac.jp.); Tomita M ( Clinical Research Center (M.T.), Tokyo Medical and Dental University, Tokyo, Japan.); Tomimitsu H ( Department of Neurology, JA Toride Medical Center (H.T., S.S.), Ibaraki, Japan.); Kamata T ( Department of Neurology, Musashino Red Cross Hospital (M.I., T.K.), Tokyo, Japan.); Fujigasaki H ( Department of Internal Medicine (H.F.), Metropolitan Bokutoh Hospital, Tokyo, Japan.); Shintani S ( Department of Neurology, JA Toride Medical Center (H.T., S.S.), Ibaraki, Japan.); Mizusawa H ( From the Department of Neurology and Neurological Science (M.I., E.I., Y.N., S.I., and H.M.).) |
| Abstract |
BACKGROUND AND PURPOSE: Predicting response to rtPA is essential in the era of endovascular therapy for stroke. The purpose of this study was to elucidate prognostic factors of early neurologic improvement and long-term outcome with respect to the development and reversion of leptomeningeal collaterals in recanalization therapy after acute ischemic stroke. MATERIALS AND METHODS: We analyzed consecutive patients with proximal MCA occlusion treated with rtPA from 2007 to 2012 at 2 hospital stroke centers. All patients routinely underwent brain MR imaging before rtPA. To assess the reversion of collateral signs, we included patients who underwent follow-up MR imaging. We assessed the development and reversion of collaterals by using a combination of 2 MR imaging collateral markers, the hyperintense vessel sign and the posterior cerebral artery laterality sign. Early neurologic improvement was defined as a decrease in the NIHSS score of ≥10 or a score of ≤2 at 24 hours of treatment. RESULTS: Early neurologic improvement was observed in 22 of 48 eligible patients. The development of collaterals at arrival (15/22 versus 9/26, P = .042) was significantly associated with early neurologic improvement. Multivariate analysis adjusting for other variables showed that the development of collaterals at arrival (OR, 4.82; 95% CI, 1.34-19.98; P = .015) was independently associated with early neurologic improvement. Reversion of collaterals was significantly associated with successful recanalization (P < .001), and multivariate analysis showed that the reversion of collaterals was an independent prognostic factor of long-term functional outcome (OR, 5.07; 95% CI, 1.38-22.09; P = .013). CONCLUSIONS: Our results indicate that the development of leptomeningeal collaterals plays a crucial role in achieving early neurologic improvement, and reversion of collaterals predicts a favorable outcome via arterial recanalization after rtPA treatment for acute stroke. |
