title: Functional outcome after recanalization for acute pure M1 occlusion of the middle cerebral artery as assessed by collateral CTA flow.
abstract: OBJECTIVE
  Collateral flow is important for ischemic brain tissue after an acute occlusion of the cerebral artery. The purpose of this study was to evaluate baseline collateral flow, on CT angiography (CTA), as a predictor of functional outcome in patients who had endovascular recanalization, after acute pure first segment (M1) occlusion of the middle cerebral artery (MCA).
  
  
  METHODS
  Thirty patients with acute pure M1 occlusion treated by endovascular recanalization, who were ineligible for intravenous thrombolysis or resistant to intravenous thrombolysis, were reviewed. The relationship between baseline collateral flow, on CTA, and functional outcome, was analyzed. In addition, other factors affecting clinical outcome were assessed.
  
  
  RESULTS
  The mean NIHSS score on admission was 16.87±4.86 (7-24). The mean time interval between onset of stroke symptoms and recanalization was 324.37±68.38 (210-463) min. Successful recanalization (TICI 2b-3) was achieved in 18 patients (60%). Twenty-seven of 30 patients improved their NIHSS score (mean 8.4); NIHSS score 8.9±5.4 (median 10, range 0-16) at seven days. Two patients had aggravated symptoms and one patient had no change on the NIHSS score. At 90 days after recanalization, a modified Rankin Scale (mRS) of ≤3 was achieved in 15 patients (50%) and a mRS of ≤2 was achieved in nine patients (30%). Symptomatic intra-cerebral hemorrhage occurred in two patients (6.7%). Multivariate regression analysis showed an initial NIHSS score (p=0.004), grade of baseline collateral flow on CTA (p=0.025), presence of diabetes mellitus (p=0.037), and TICI scale (p=0.049) were factors associated with an improved NIHSS. For the mRS at 90 days, only the grade of the baseline collateral flow on CTA was associated with a good functional outcome (p=0.013).
  
  
  CONCLUSIONS
  The results of this study suggest that the grade of baseline collateral flow, on CTA, is an independent predictor of functional outcome for endovascular recanalization of acute pure M1 occlusion of the middle cerebral artery.
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea. Electronic address: aminoff@hanmail.net.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Sung
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Diagnostic Radiology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Tae Hong
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Han Jin
authors.initials: HJ
authors.lastname: Cho
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Kang
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurology, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Dae Soo
authors.initials: DS
authors.lastname: Jung
authors.affiliation: Department of Neurology, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Kyung Pil
authors.initials: KP
authors.lastname: Park
authors.affiliation: Department of Neurology, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Min Kyu
authors.initials: MK
authors.lastname: Park
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurosurgery, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Jae Il
authors.initials: JI
authors.lastname: Lee
authors.affiliation: Stroke Center, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea; Department of Neurosurgery, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea.
authors.forename: Jun Kyeung
authors.initials: JK
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage; D002560:Cerebrovascular Circulation / Q000502:physiology*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care
keywords: Acute ischemic stroke; Collateral flow; Endovascular recanalization; First segment of the middle cerebral artery; Functional outcome