Statin enhancement of collateralization in acute stroke

Ovbiagele, Bruce; Saver, Jeffrey L.; Starkman, Sidney; Kim, D.; Ali, Latisha K; Jahan, Reza; Duckwiler, Gary; Viñuela, Fernando; Pineda, Sandra; Liebeskind, David S

doi:10.1212/01.wnl.0000264931.34941.f0

Cited by 115 publications

(84 citation statements)

References 7 publications

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“…To our knowledge, this is the first study to quantitatively show a predictive value of the collateral blood flow delay independent of the morphologic collateral grade. Qualitative assessment of hemodynamic and morphologic parameters of leptomeningeal collaterals has been used in catheter angiography grading systems and has been shown to predict a favorable outcome, [24][25][26] showing the importance of enhancement time for collateral quality. Saito et al 27 assessed the correlation of transit time from the ICA to the M2 segment with the lesion size on follow-up NECT.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Beyer¹,

Baumgarten

Thierfelder³

et al. 2014

J Cereb Blood Flow Metab

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The velocity of collateral filling can be assessed in dynamic time-resolved computed tomography (CT) angiographies and may predict initial CT perfusion (CTP) and follow-up lesion size. We included all patients with an M1 ± internal carotid artery (ICA) occlusion and follow-up imaging from an existing cohort of 1791 consecutive patients who underwent multimodal CT for suspected stroke. The velocity of collateral filling was quantified using the delay of time-to-peak (TTP) enhancement of the M2 segment distal to the occlusion. Cerebral blood volume (CBV) and mean transit time (MTT)-CBV mismatch were assessed in initial CTP. Follow-up lesion size was assessed by magnetic resonance imaging (MRI) or non-enhanced CT (NECT). Multivariate analyses were performed to adjust for extent of collateralization and type of treatment. Our study comprised 116 patients. Multivariate analysis showed a short collateral blood flow delay to be an independent predictor of a small CBV lesion (P o 0.001) and a large relative mismatch (P o 0.001) on initial CTP, of a small follow-up lesion (P o 0.001), and of a small difference between initial CBV and follow-up lesion size (P = 0.024). Other independent predictors of a small lesion on follow-up were a high morphologic collateral grade (P = 0.001), lack of an additional ICA occlusion (P = 0.009), and intravenous thrombolysis (P = 0.022). Fast filling of collaterals predicts initial CTP and follow-up lesion size and is independent of extent of collateralization.

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Section: Discussionmentioning

confidence: 99%

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Beyer¹,

Baumgarten

Thierfelder³

et al. 2014

J Cereb Blood Flow Metab

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“…1,3,5,9,21 Despite the gains made until now in understanding leptomeningeal collaterals, we do not fully understand the range or reasons for this variability. 1,22 In this study, we use a new imaging tool, dCTA, to study leptomeningeal collaterals in a uniform cohort of patients with M1 MCA þ / À intracranial ICA occlusions. We present some properties of leptomeningeal collaterals not previously described in human imaging studies.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Leptomeningeal Collaterals Using Dynamic CT Angiography in Patients with Acute Ischemic Stroke

Menon

O’Brien

Bivard

et al. 2012

J Cereb Blood Flow Metab

153

120

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Whole-brain dynamic time-resolved computed tomography angiography (CTA) is a technique developed on the new 320-detector row CT scanner capable of generating time-resolved cerebral angiograms from skull base to vertex. Unlike a conventional cerebral angiogram, this technique visualizes pial arterial filling in all vascular territories, thereby providing additional hemodynamic information. Ours was a retrospective study of consecutive patients with ischemic stroke and M1 middle cerebral artery þ / À intracranial internal carotid artery occlusions presenting to our center from June 2010 and undergoing dynamic timeresolved CTA and perfusion CT within 6 hours of symptom onset. Leptomeningeal collateral status was assessed by determining relative prominence of pial arteries in the ischemic region, rate and extent of retrograde flow, and various topographical patterns of pial arterial filling. Twenty-five patients were included in the study. We demonstrate the existence of the following novel properties of leptomeningeal collaterals in humans: (a) posterior (posterior cerebral artery (PCA)-MCA) dominant collateralization, (b) intraterritorial 'within MCA region' leptomeningeal collaterals, and (c) significant variability in size, extent, and retrograde filling time in pial arteries. We also describe a simple and reliable collateral grading template that, for the first time on dynamic CTA, incorporates back-filling time as well as size and extent of collateral filling.

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“…Statins lower cholesterol production and promote hepatic removal of LDL cholesterol in serum. Aside from their conventional use reducing cholesterol levels, statins have been broadly used in many other clinical conditions, for instance cardiovascular (6) or cerebrovascular stroke (7), and Alzheimer's disease (AD) (8). There is growing evidence that statins may exert additional effects on neuroprotection, independently oftheireffects on cholesterol synthesis.…”

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confidence: 99%

Neuroprotective and Anti-Inflammatory Activities of Atorvastatin in a Rat Chronic Constriction Injury Model

Chu

Chen

et al. 2012

Int J Immunopathol Pharmacol

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The first two authors contributed equally to this work Atorvastatin is an HMG-CoA reductase inhibitor used to treat hypercholesterolemic conditions associated with hypertension. This study aims to investigate the anti-inflammatory and neuroprotective effects of atorvastatin on peripheral neuropathic pain. Peripheral neuropathic pain was induced by chronic constriction injury (CCI) in Sprague-Dawley rats. Rats were divided into 3 groups including shamoperated, CCI, and atorvastatin-treated. Atorvastatin (10 mg/kg) or phosphate-buffered saline was orally administered for 2 weeks. All animals were assessed by neurobehavioral tests before surgery and at days 3,7,14 after surgery. Inflammatory and neuroprotective factors were evaluated by Western blot analysis. eNOS, COX2 and iNOS in the sciatic nerve were also studied using immunohistochemistry. Atorvastatin attenuated CCI-induced nociceptive sensitization and thermal hyperalgesia in a time-dependent manner. Atorvastatin improved CCI-induced neurobehavioral/inflammatory activity by inhibition of TGF-p, pIKB/lKB, NFKB, COX2, iNOS, EP1 and EP4 in the sciatic nerve. Atorvastatin was also found to increase neuroprotection factors pAktlAkt, eNOS and VEGF. Taken together, these data indicate that atorvastatin could protect the sciatic nerve against CCI-induced neuroinflammation and nociception.Neuropathic pain, largely resulting from primary lesions in the peripheral nerve or from malfunctions in the central nervous system (CNS), has an extremely negative impact on the quality of life of patients affected by this condition (1).Studies using the chronic constriction injury (CCI) model of peripheral nerve injury have provided a deeper understanding of nociception and the events contributing to the pathogenesis of chronic pain conditions (2). Inflammatory states within the

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Statin enhancement of collateralization in acute stroke

Cited by 115 publications

References 7 publications

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

Assessment of Leptomeningeal Collaterals Using Dynamic CT Angiography in Patients with Acute Ischemic Stroke

Neuroprotective and Anti-Inflammatory Activities of Atorvastatin in a Rat Chronic Constriction Injury Model

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