title: 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 artery ± 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 = 206) were: mean age = 66.9 ± 11.6 years, median baseline National Institutes of Health Stroke Scale = 14 (interquartile range [IQR] = 11-20), and median time from stroke symptom onset to CTA = 166 minutes (IQR = 96-262). Poor collateral status at baseline (rLMC score = 0-10) was seen in 73 of 206 patients (35.4%). On univariate analyses, patients with poor collateral status at baseline were older; were hypertensive; 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] = 3.22, 95% confidence interval [CI] = 1.69-6.15, p < 0.001), hyperuricemia (per 1mg/dl serum uric acid; OR = 1.35, 95% CI = 1.12-1.62, p < 0.01), and older age (per 10 years; OR = 1.34, 95% CI = 1.02-1.77, p = 0.03) as independent predictors of poor leptomeningeal collateral status at baseline.
  
  
  CONCLUSIONS
  Metabolic syndrome, hyperuricemia, and age are associated with poor leptomeningeal collateral status in patients with acute ischemic stroke.
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Menon
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.forename: Shelagh B
authors.initials: SB
authors.lastname: Coutts
authors.forename: Donald G
authors.initials: DG
authors.lastname: Welsh
authors.forename: James E
authors.initials: JE
authors.lastname: Faber
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: Zaheed
authors.initials: Z
authors.lastname: Damani
authors.forename: Kyung-Hee
authors.initials: KH
authors.lastname: Cho
authors.forename: Hyuk-Won
authors.initials: HW
authors.lastname: Chang
authors.forename: Jeong-Ho
authors.initials: JH
authors.lastname: Hong
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Sohn
mesh_terms: D000368:Aged; D001099:Arachnoid / Q000098:blood supply* / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D003097:Collateral Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000453:epidemiology; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology; D008875:Middle Aged; D010841:Pia Mater / Q000098:blood supply* / Q000000981:diagnostic imaging; D011859:Radiography; D012042:Registries; D012307:Risk Factors; D016037:Single-Blind Method; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*
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