Clinical significance of evaluation of collateral circulation in short-term prognosis of wake-up stroke patients

Abstract

Background. In recent years, the clinical significance of collateral circulation in vascular embolism has been gradually found.Objectives. To investigate the relationship between collateral circulation and short-term prognosis of wakeup stroke patients. Materials and methods.The present observational study enrolled 269 cases of wake-up ischemic stroke patients. All patients presented with mismatched low perfusion volume/main infraction volume and received thrombolytic therapy after admission. The hemorrhagic transformation rate was recorded. The American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading was used for evaluation of collateral circulation. The stroke condition was determined using the National Institutes of Health Stroke Scale (NIHSS). The Barthel Index (BI) score was used for measurement of quality of life. The Modified Rankin Scale (mRS) was used for measurement of prognosis.Results. The hypertension, diabetes and current smoker rates were significantly higher. The baseline NHISS scores and NIHSS scores after 24 h were remarkably lower. The NIHSS scores were markedly lower in ASITN/SIR grade 2-3 patients compared with ASITN/SIR grade 0-1 patients at 1 week, 2 weeks, 4 weeks, and 3 months after treatment. Patients with ASITN/SIR grade 2-3 had lower mRS score and higher BI scores. The ASITN/ SIR grade was an independent risk factor for bad prognosis of wake-up ischemic stroke patients in 3 months. Conclusions.Collateral circulation condition may be associated with short-term prognosis of wake-up stroke patients. Patients with worse collateral circulation may present higher risk for bad short-term prognosis.

Multimodal CT Imaging Characteristics in Predicting Prognosis of Wake-Up Stroke

“…Previous meta-analysis showed that patients with better collateral circulation could have a smaller ischemic core on perfusion and less severe neurological symptoms at baseline and have a better chance of achieving a favorable or excellent functional outcome at 3 or 6 months after the index stroke ( 18 ). Another study ( 14 ) used CTA for WUS evaluation and found that collateral circulation condition graded by the ASITN/SIR was an independent risk factor for bad prognosis of wake-up ischemic stroke patients in 3 months. In this study, we found good collateral circulation (2–3 score) was a strong predictor for good outcome in WUS with relatively larger AUC than the penumbra volume.…”

“…Recently published studies proposed different imaging evaluation criteria for WUS (11)(12)(13)(14). One study (11) suggested that WUS should be evaluated by using the ratio of ischemic penumbra to hypo-perfusion area >50% on CTP.…”

“…One study ( 13 ) used CTP for WUS evaluation and showed that CTP core volume (β = 0.403, p = 0.000) could predict NIHSS at 7 days in a multivariate analysis. While another study ( 14 ) used CTA for WUS evaluation and found that collateral circulation condition graded by the ASITN/SIR was an independent influencing factor for prognosis of wake-up ischemic stroke patients at 3 months. Although other studies attempt to predict the prognosis of WUS by using ischemic core on perfusion volume and collateral circulation, a major weakness of both studies was using separate indexes from just a single modality of CTP or CTA instead of multimodality assessment.…”