title: CTA collateral status and response to recanalization in patients with acute ischemic stroke.
abstract: OBJECTIVE
  Collateral status at baseline is an independent determinant of clinical outcome among patients with acute ischemic stroke. We sought to identify whether the association between recanalization after intra-arterial acute stroke therapy and favorable clinical response is modified by the presence of good collateral flow assessed on baseline CTA.
  
  
  METHODS
  Data are from the Keimyung Stroke Registry, a prospective cohort study of patients with acute ischemic stroke from Daegu, South Korea. Patients with M1 segment MCA with or without intracranial ICA occlusions on baseline CTA from May 2004 to July 2009 who also had baseline MR imaging were included. Two readers blinded to all clinical information assessed baseline and follow-up imaging. Leptomeningeal collaterals on baseline CTA were assessed by consensus by use of the regional leptomeningeal score.
  
  
  RESULTS
  Among 84 patients (mean age, 65.2 ± 13.2 years; median NIHSS score, 14; interquartile range, 8.5), median time from stroke onset to initial MR imaging was 164 minutes. TICI 2b-3 recanalization was achieved in 38.1% of patients and mRS 0-2 at 90 days in 35.8% of patients. In a multivariable model, the interaction between collateral status and recanalization was significant. Only patients with intermediate or good collaterals who recanalized showed a statistically significant association with good clinical outcome (rate ratio = 3.8; 95% CI, 1.2-12.1). Patients with good and intermediate collaterals who did not achieve recanalization and patients with poor collaterals, even if they achieved recanalization, did not do well.
  
  
  CONCLUSIONS
  Patients with good or intermediate collaterals on CTA benefit from intra-arterial therapy, whereas patients with poor collaterals do not benefit from treatment.
authors.affiliation: From the Calgary Stroke Program, Departments of Clinical Neurosciences (V.N., M.A.A., S.M., E.Q., M.E., A.M.D., M.G., M.D.H., B.K.M.).
authors.forename: V
authors.initials: V
authors.lastname: Nambiar
authors.affiliation: Departments of Neurology (S.I.S.).
authors.forename: S I
authors.initials: SI
authors.lastname: Sohn
authors.affiliation: From the Calgary Stroke Program, Departments of Clinical Neurosciences (V.N., M.A.A., S.M., E.Q., M.E., A.M.D., M.G., M.D.H., B.K.M.)Department of Internal Medicine (M.A.A.), King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: M A
authors.initials: MA
authors.lastname: Almekhlafi
authors.affiliation: Radiology (H.W.C.), Brain Research Institute, Keimyung University, Daegu, South Korea.
authors.forename: H W
authors.initials: HW
authors.lastname: Chang
authors.affiliation: From the Calgary Stroke Program, Departments of Clinical Neurosciences (V.N., M.A.A., S.M., E.Q., M.E., A.M.D., M.G., M.D.H., B.K.M.).
authors.forename: S
authors.initials: S
authors.lastname: Mishra
authors.affiliation: From the Calgary Stroke Program, Departments of Clinical Neurosciences (V.N., M.A.A., S.M., E.Q., M.E., A.M.D., M.G., M.D.H., B.K.M.).
authors.forename: E
authors.initials: E
authors.lastname: Qazi
authors.affiliation: From the Calgary Stroke Program, Departments of Clinical Neurosciences (V.N., M.A.A., S.M., E.Q., M.E., A.M.D., M.G., M.D.H., B.K.M.)Radiology (M.E., A.M.D., M.G., M.D.H., B.K.M.).
authors.forename: M
authors.initials: M
authors.lastname: Eesa
authors.affiliation: From the Calgary Stroke Program, Departments of Clinical Neurosciences (V.N., M.A.A., S.M., E.Q., M.E., A.M.D., M.G., M.D.H., B.K.M.)Radiology (M.E., A.M.D., M.G., M.D.H., B.K.M.)Hotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: From the Calgary Stroke Program, Departments of Clinical Neurosciences (V.N., M.A.A., S.M., E.Q., M.E., A.M.D., M.G., M.D.H., B.K.M.)Radiology (M.E., A.M.D., M.G., M.D.H., B.K.M.)Hotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Goyal
authors.affiliation: From the Calgary Stroke Program, Departments of Clinical Neurosciences (V.N., M.A.A., S.M., E.Q., M.E., A.M.D., M.G., M.D.H., B.K.M.)Radiology (M.E., A.M.D., M.G., M.D.H., B.K.M.)Community Health Sciences (M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, CanadaHotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: M D
authors.initials: MD
authors.lastname: Hill
authors.affiliation: From the Calgary Stroke Program, Departments of Clinical Neurosciences (V.N., M.A.A., S.M., E.Q., M.E., A.M.D., M.G., M.D.H., B.K.M.)Radiology (M.E., A.M.D., M.G., M.D.H., B.K.M.)Community Health Sciences (M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, CanadaHotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada. docbijoymenon@gmail.com.
authors.forename: B K
authors.initials: BK
authors.lastname: Menon
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D002548:Cerebral Revascularization; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome