Leptomeningeal collateral status predicts outcome after middle cerebral artery occlusion

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Acute ischemic stroke due to large vessel anterior occlusion is a devastating event that often leads to long‐term disability or death in spite of recent advances in treatment.1 In the event of a middle cerebral artery (MCA) occlusion, perfusion via leptomeningeal collateral vessels may preserve brain tissue at risk of infarction in the ischemic border zone.3 Indeed, the extent of collateral circulation has been shown to correlate with the final size of infarction and long‐term functional outcome.5 This also applies in the case of revascularization with intravenous thrombolysis (IV‐tPA) and/or mechanical thrombectomy, where collateral status has been shown to influence the rates of recanalization and hemorrhagic transformation and ultimately the long‐term clinical outcome.6
While digital subtraction angiography (DSA) is still considered gold standard in evaluating collateral status, the procedure is time‐consuming, requires more resources, and has a higher rate of complications compared to non‐invasive modalities.14 Computed tomography angiography (CTA) provides a rapid assessment of leptomeningeal collaterals and has proven reliable in predicting the fate of the ischemic border zone, the risk of in‐hospital neurological deterioration (measured as a decline in National Institute of Health Stroke Scale (NIHSS) score from admission to discharge), and long‐term functional outcome.3
The aim of this study was to evaluate whether leptomeningeal collateral status on CTA can predict early neurological improvement (ENI), long‐term functional outcome, hemorrhagic transformation, and mortality in consecutive patients with acute ischemic stroke due to MCA occlusion receiving IV‐tPA and in some cases mechanical thrombectomy.
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