Translesional pressure gradient and leptomeningeal collateral status in symptomatic middle cerebral artery stenosis
Open Access
- 24 November 2017
- journal article
- research article
- Published by Wiley in European Journal of Neurology
- Vol. 25 (2), 404-410
- https://doi.org/10.1111/ene.13521
Abstract
Background and purpose Leptomeningeal collateral (LMC) status governs the prognosis of large artery occlusive stroke, although factors determining LMC status are not fully elucidated. The aim was to investigate metrics affecting LMC status in such patients by using computational fluid dynamics (CFD) models based on computed tomography angiography (CTA). Methods In this cross‐sectional study, patients with recent ischaemic stroke or transient ischaemic attack attributed to atherosclerotic M1 middle cerebral artery (MCA) stenosis (50%–99%) were recruited. Demographic, clinical and imaging data of these patients were collected. Ipsilesional LMC status was graded as good or poor by assessing the laterality of anterior and posterior cerebral arteries in CTA. A CFD model based on CTA was constructed to reflect focal hemodynamics in the distal internal carotid artery, M1 MCA and A1 anterior cerebral artery. Pressure gradients were calculated across culprit MCA stenotic lesions in CFD models. Predictors for good LMC status were sought in univariate and multivariate analyses. Results Amongst the 85 patients enrolled (mean age 61.5 ± 10.9 years), 38 (44.7%) had good ipsilesional LMC status. The mean pressure gradient across MCA lesions was 14.8 ± 18.1 mmHg. Advanced age (P = 0.030) and a larger translesional pressure gradient (P = 0.029) independently predicted good LMCs. A lower fasting blood glucose level also showed a trend for good LMCs (P = 0.058). Conclusions Our study suggested a correlation between translesional pressure gradient and maturation of LMCs in intracranial atherosclerotic disease. Further studies with more exquisite and dynamic monitoring of cerebral hemodynamics and LMC evolution are needed to verify the current findings.Keywords
Funding Information
- National Natural Science Foundation of China (N_CUHK421/16)
- China National Funds for Distinguished Young Scientists (81601000)
This publication has 24 references indexed in Scilit:
- The collateral circulation of the heartBMC Medicine, 2013
- Leptomeningeal collaterals are associated with modifiable metabolic risk factorsAnnals of Neurology, 2013
- Posterior Cerebral Artery Laterality on Magnetic Resonance Angiography Predicts Long-Term Functional Outcome in Middle Cerebral Artery OcclusionStroke, 2013
- Significance of Good Collateral Compensation in Symptomatic Intracranial AtherosclerosisCerebrovascular Diseases, 2012
- Different effect of hyperglycemia on stroke outcome in non-diabetic and diabetic patients — a cohort studyNeurological Research, 2012
- Clinical and Radiological Outcomes after Intracranial Atherosclerotic Stroke: A Comprehensive Approach Comparing Stroke SubtypesCerebrovascular Diseases, 2011
- Collaterals dramatically alter stroke risk in intracranial atherosclerosisAnnals of Neurology, 2010
- MR Mismatch Profiles in Patients with Intracranial Atherosclerotic Stroke: A Comprehensive approach Comparing Stroke SubtypesJournal of Cerebral Blood Flow & Metabolism, 2009
- Collateral CirculationStroke, 2003
- Persistent Poststroke Hyperglycemia Is Independently Associated With Infarct Expansion and Worse Clinical OutcomeStroke, 2003