Leukoaraiosis and collaterals in acute ischemic stroke.
BACKGROUND
We examined the correlation of angiographic collaterals in acute stroke with the presence, extent, and distribution of white matter changes, so-called Leukoaraiosis, in an effort to determine if Leukoaraiosis indicates chronic cerebral hypoperfusion and/or is associated with the development of cerebral collateral circulation.


METHODS
Consecutive acute strokes due to large-vessel occlusion on angiography had preprocedure CT or MRI white matter changes graded utilizing the Fazekas scale incorporating deep and periventricular components. Angiographic collaterals evaluated with a 5-point scale were correlated with leukoaraiosis.


RESULTS
Collaterals were evaluated in 102 cases (51 men, 51 women; mean age 66 (SD 18) years with acute occlusions of the proximal middle cerebral artery (MCA) (47%), distal internal carotid artery (ICA) (28%), distal MCA (9%), basilar (7%), proximal ICA (7%), vertebral (1%), posterior cerebral artery (PCA) (1%), and common carotid artery (CCA) (1%). Collateral grade was well distributed across the scale. Periventricular and deep white matter changes were evident in 34% and 51% of cases, respectively. Collateral grade exhibited no relationship with either the presence or extent of periventricular disease (P= .772, r= .029) or deep white matter changes (P= .559, r=-.059).


CONCLUSIONS
Leukoaraisosis exhibits no overt relationship with the extent of collaterals measured at angiography in acute ischemic stroke. Chronic small-vessel disease may be a distinct pathophysiologic entity unrelated to arteriogenesis and compensatory aspects of collateral flow.
Department of Neurology, University of Southern California, CA, USA. sanossia@yahoo.com
Nerses
N
Sanossian
Bruce
B
Ovbiagele
Jeffrey L
JL
Saver
Jeffry R
JR
Alger
Sidney
S
Starkman
Doojin
D
Kim
Arbi G
AG
Ohanian
Brian H
BH
Buck
Latisha K
LK
Ali
Gary R
GR
Duckwiler
Reza
R
Jahan
Fernando
F
Viñuela
David S
DS
Liebeskind
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000473:pathology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000473:pathology