Leptomeningeal Collaterals Are Associated with Modifiable Metabolic Risk Factors

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 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.