title: Association of Collateral Blood Vessels Detected by Arterial Spin Labeling Magnetic Resonance Imaging With Neurological Outcome After Ischemic Stroke.
abstract: Robust collateral blood vessels have been associated with better neurologic outcome following acute ischemic stroke (AIS). The most commonly used methods for identifying collaterals are contrast-based angiographic imaging techniques, which are not possible in all patients after AIS.
  
  
  
  To assess the association between the presence of collateral vessels identified using arterial spin labeling (ASL) magnetic resonance imaging, a technique that does not require exogenous administration of contrast, and neurologic outcome in patients after AIS.
  
  
  
  This retrospective cohort study examined 38 patients after AIS admitted to a tertiary academic medical center between 2012 and 2014 who underwent MRI with ASL.
  
  
  
  According to a prespecified hypothesis, ASL images were graded for the presence of collaterals by 2 neuroradiologists. Modified Rankin Scale (mRS) scores at discharge and other composite data were abstracted from the medical record by a neurologist blinded to radiologic data.
  
  
  
  Of the 38 patients, 19 (50.0%) were male, and the mean (SD) age was 61 (20) years. In 25 of 38 patients (65.8%), collaterals were detected using ASL, which were significantly associated with both a good outcome (mRS score of 0-2 at discharge; P = .02) and a 1-point decrease in mRS score at discharge (odds ratio, 6.4; 95% CI, 1.7-23.4; P = .005). In a multivariable ordinal logistic regression model, controlling for admission National Institutes of Health Stroke Scale score, history of atrial fibrillation, premorbid mRS score, and stroke parent artery status, there was a strong association between the presence of ASL collaterals and a 1-point decrease in the mRS score at discharge (odds ratio, 5.1; 95% CI, 1.2-22.1; P = .03).
  
  
  
  Following AIS, the presence of ASL collaterals is strongly associated with better neurological outcome at hospital discharge. This novel association between ASL collaterals and improved neurologic outcome may help guide prognosis and management, particularly in patients who are unable to undergo contrast-based radiological studies.
authors.affiliation: Department of Neurology, University of Utah, Salt Lake City.
authors.forename: Adam
authors.initials: A
authors.lastname: de Havenon
authors.affiliation: Department of Radiology, University of Washington, Seattle.
authors.forename: David R
authors.initials: DR
authors.lastname: Haynor
authors.affiliation: Department of Neurology, University of Washington, Seattle.
authors.forename: David L
authors.initials: DL
authors.lastname: Tirschwell
authors.affiliation: Department of Neurology, University of Utah, Salt Lake City.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Majersik
authors.affiliation: Department of Neurology, University of Utah, Salt Lake City.
authors.forename: Gordon
authors.initials: G
authors.lastname: Smith
authors.affiliation: Department of Radiology, University of Washington, Seattle.
authors.forename: Wendy
authors.initials: W
authors.lastname: Cohen
authors.affiliation: Department of Radiology, University of Washington, Seattle.
authors.forename: Jalal B
authors.initials: JB
authors.lastname: Andre
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications; D015331:Cohort Studies; D003097:Collateral Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D016017:Odds Ratio; D013113:Spin Labels; D020521:Stroke / Q000150:complications* / Q000209:etiology
chemical_list: D013113:Spin Labels