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Translesional pressure gradient and leptomeningeal collateral status in symptomatic middle cerebral artery stenosis.

Translesional pressure gradient and leptomeningeal collateral status in symptomatic middle cerebral artery stenosis.
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Leng X, Lan L, Ip HL, Fan F, Ma SH, Ma K, Liu H, Yan Z, Liu J, Abrigo J, Soo YO, Liebeskind DS, Wong KS, Leung TW,


Leng X, Lan L, Ip HL, Fan F, Ma SH, Ma K, Liu H, Yan Z, Liu J, Abrigo J, Soo YO, Liebeskind DS, Wong KS, Leung TW, (click to view)

Leng X, Lan L, Ip HL, Fan F, Ma SH, Ma K, Liu H, Yan Z, Liu J, Abrigo J, Soo YO, Liebeskind DS, Wong KS, Leung TW,

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European journal of neurology 2017 11 24() doi 10.1111/ene.13521
Abstract
BACKGROUND AND PURPOSE
Leptomeningeal collateral (LMC) status governs prognosis of large artery occlusive stroke, while factors determining the LMC status were not fully elucidated. We aimed to investigate metrics affecting LMC status in such patients by using computational fluid dynamics (CFD) models based on CT angiography (CTA).

METHODS
In this cross-sectional study, we recruited patients with recent ischemic stroke or transient ischemic attack attributed to atherosclerotic M1 middle cerebral artery (MCA) stenosis (50-99%). We collected demographic, clinical and imaging data of these patients. We graded ipsilesional LMC status as good or poor by assessing the laterality of anterior and posterior cerebral arteries in CTA. We constructed a CFD model based on CTA to reflect focal hemodynamics in distal internal carotid artery, M1 MCA and A1 anterior cerebral artery. We calculated pressure gradients across culprit MCA stenotic lesions in CFD models. We explored for predictors for good LMC status in univariate and multivariate analyses.

RESULTS
Among the 85 patients enrolled (mean age 61.5±10.9 years), 38 (44.7%) had good ipsilesional LMC status. The mean pressure gradient across MCA lesions was 14.8±18.1 mmHg. Advanced age (p=0.030) and a larger translesional pressure gradient (p=0.029) independently predicted good LMC. A lower fasting blood glucose level also showed a trend for good LMC (p=0.058).

CONCLUSIONS
Our study suggested a correlation between translesional pressure gradient and maturation of leptomeningeal collaterals in intracranial atherosclerotic disease. Further studies with more exquisite and dynamic monitoring of cerebral hemodynamics and LMC evolution are needed to verify the current findings. This article is protected by copyright. All rights reserved.

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