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Research ArticleAdult Brain

Reduced Leukoaraiosis, Noncardiac Embolic Stroke Etiology, and Shorter Thrombus Length Indicate Good Leptomeningeal Collateral Flow in Embolic Large-Vessel Occlusion

T. Hashimoto, T. Kunieda, T. Honda, F. Scalzo, L. Ali, J.D. Hinman, N.M. Rao, M. Nour, M. Bahr-Hosseini, J.L. Saver, R. Raychev and D. Liebeskind
American Journal of Neuroradiology January 2022, 43 (1) 63-69; DOI: https://doi.org/10.3174/ajnr.A7360
T. Hashimoto
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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  • ORCID record for T. Hashimoto
T. Kunieda
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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  • ORCID record for T. Kunieda
T. Honda
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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F. Scalzo
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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  • ORCID record for F. Scalzo
L. Ali
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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J.D. Hinman
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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N.M. Rao
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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M. Nour
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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M. Bahr-Hosseini
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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  • ORCID record for M. Bahr-Hosseini
J.L. Saver
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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R. Raychev
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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D. Liebeskind
aFrom the Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, California
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  • FIG 1.
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    FIG 1.

    Exemplary cases of an imaging assessment with good (A–D) and poor (E–H) acute leptomeningeal collateral flow. A, CTA shows right proximal MCA occlusion (arrow) with a collateral score of 3. B, MR imaging shows mild leukoaraiosis with a total Fazekas score of 1. C, Delayed-phase CTA shows a short occlusive thrombus identified by the filling defect of contrast (between arrowheads, with a tracer tool for measuring thrombus length). D, NCCT shows an occlusive thrombus with the placement of a single ROI for measuring Hounsfield unit density (outlined region). E, CTA shows right proximal MCA occlusion (arrow) with a collateral score of zero. F, MR imaging shows severe leukoaraiosis with a total Fazekas score of 5. G, Delayed-phase CTA shows a long occlusive thrombus identified by the filling defect of contrast (between arrowheads, with a tracer tool for measuring thrombus length). H, NCCT shows an occlusive thrombus on multiple slices, with the placement of 2 ROIs for measuring Hounsfield unit density (outlined regions).

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    FIG 2.

    Flow diagram of the patients screened, enrolled, and analyzed in the study. ICT indicates internal carotid artery terminus.

Tables

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    Table 1:

    Clinical indicators independently associated with good acute leptomeningeal collateral flow on multivariate analysis

    OR95% CIP Value
    Female sex0.590.17–1.93.38
    Age (for 1-year increase)1.040.99–1.09.10
    NIHSS score on admission (for 1-point increase)0.950.88–1.04.29
    Cardioembolic stroke subtype0.170.02–0.87.03
    Reduced leukoaraiosis (total Fazekas scores of 0–2)9.572.49–47.75<.001
    Thrombus length (for 1-mm increase)0.930.84–1.01.07
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    Table 2:

    Clinical indicators independently associated with good acute leptomeningeal collateral flow in patients with cardioembolic stroke on multivariate analysis

    OR95% CIP Value
    Female sex0.810.21–2.87.74
    Age (for 1-year increase)1.030.99–1.09.14
    NIHSS score on admission (for 1-point increase)0.950.86–1.04.26
    Blood glucose level (for 1-mmol/L increase)0.870.64–1.13.30
    Reduced leukoaraiosis (total Fazekas scores of 0–2)5.791.40–29.61.01
    Thrombus length (for 1-mm increase)0.910.82–0.99.04
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American Journal of Neuroradiology: 43 (1)
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T. Hashimoto, T. Kunieda, T. Honda, F. Scalzo, L. Ali, J.D. Hinman, N.M. Rao, M. Nour, M. Bahr-Hosseini, J.L. Saver, R. Raychev, D. Liebeskind
Reduced Leukoaraiosis, Noncardiac Embolic Stroke Etiology, and Shorter Thrombus Length Indicate Good Leptomeningeal Collateral Flow in Embolic Large-Vessel Occlusion
American Journal of Neuroradiology Jan 2022, 43 (1) 63-69; DOI: 10.3174/ajnr.A7360

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Reduced Leukoaraiosis, Noncardiac Embolic Stroke Etiology, and Shorter Thrombus Length Indicate Good Leptomeningeal Collateral Flow in Embolic Large-Vessel Occlusion
T. Hashimoto, T. Kunieda, T. Honda, F. Scalzo, L. Ali, J.D. Hinman, N.M. Rao, M. Nour, M. Bahr-Hosseini, J.L. Saver, R. Raychev, D. Liebeskind
American Journal of Neuroradiology Jan 2022, 43 (1) 63-69; DOI: 10.3174/ajnr.A7360
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