Leptomeningeal Collaterals Are Associated with Modifiable Metabolic Risk Factors
- 장혁원; 홍정호; 손성일
- Alternative Author(s)
- Chang, Hyuk Won; Hong, Jeong Ho; Sohn, Sung Il
- Publication Year
- 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 arter-
y 6 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 5 206) were: mean age 5 66.9 6 11.6 years, median baseline National Institutes
of Health Stroke Scale 5 14 (interquartile range [IQR] 5 11–20), and median time from stroke symptom onset to
CTA 5 166 minutes (IQR 5 96–262). Poor collateral status at baseline (rLMC score 5 0–10) was seen in 73 of 206
patients (35.4%). On univariate analyses, patients with poor collateral status at baseline were older; were hyperten-
sive; 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] 5 3.22, 95% confi-
dence interval [CI] 5 1.69–6.15, p < 0.001), hyperuricemia (per 1mg/dl serum uric acid; OR 5 1.35, 95% CI 5 1.12–
1.62, p < 0.01), and older age (per 10 years; OR 5 1.34, 95% CI 5 1.02–1.77, p 5 0.03) as independent predictors
of poor leptomeningeal collateral status at baseline.
Interpretation: Metabolic syndrome, hyperuricemia, and age are associated with poor leptomeningeal collateral sta-
tus in patients with acute ischemic stroke.
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