期刊
ANNALS OF NEUROLOGY
卷 69, 期 6, 页码 963-974出版社
WILEY
DOI: 10.1002/ana.22354
关键词
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资金
- NIH (NINDS) [K23NS054084, P50NS044378, 1 K24 NS050307, 1 R01 NS051688-01]
- American Academy of Neurology Foundation
- US Public Health Service [1R01 NS36643, U01 NS058728]
- National Institute of Neurological Disorders and Stroke (NINDS)
- NIH
- Emory University [M01 RR00039]
- Case Western University
- Metro Health Medical Center [5M01 RR00080]
- San Francisco General Hospital [M01 RR00083-42]
- Johns Hopkins University School of Medicine [M01 RR000052]
- Indiana University School of Medicine [5M01 RR000750-32]
- Cedars-Sinai Hospital [M01 RR00425]
- University of Maryland [M01 RR165001]
- Concentric Medical
- CoAxia
- AGA Medical
- Boehringer Ingelheim
- Bristol Myers Squibb
- Bristol-Myers Squibb/Sanofi-Aventis
Objective: Stroke risk due to intracranial atherosclerosis increases with degree of arterial stenosis. We evaluated the previously unexplored role of collaterals in modifying stroke risk in intracranial atherosclerosis and impact on subsequent stroke characteristics. Methods: Collateral flow was graded in blind fashion on 287 of 569 baseline angiograms (stenoses of 50-99% and adequate collateral views) in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. Statistical models predicted stroke in the symptomatic arterial territory based on collateral flow grade, percentage of stenosis, and previously demonstrated independent covariates. Results: Across all stenoses, extent of collaterals was a predictor for subsequent stroke in the symptomatic arterial territory (hazard ratio [HR] none vs good, 1.14; 95% confidence interval [CI], 0.39-3.30; poor vs good, 4.36; 95% CI, 1.46-13.07; p < 0.0001). For 70 to 99% stenoses, more extensive collaterals diminished risk of subsequent territorial stroke (HR none vs good, 4.60; 95% CI, 1.03-20.56; poor vs good, 5.90; 95% CI, 1.25-27.81; p = 0.0427). At milder degrees of stenoses (50-69%), presence of collaterals was associated with greater likelihood of subsequent stroke (HR none vs good, 0.18; 95% CI, 0.04-0.82; poor vs good, 1.78; 95% CI, 0.37-8.57; p < 0.0001). In multivariate analyses, extent of collaterals was an independent predictor for subsequent stroke in the symptomatic arterial territory (HR none vs good, 1.62; 95% CI, 0.52-5.11; poor vs good, 4.78; 95% CI, 1.55-14.7; p = 0.0019). Interpretation: Collateral circulation is a potent determinant of stroke risk in intracranial atherosclerosis, demonstrating a protective role with severe stenoses and identifying more unstable milder stenoses. ANN NEUROL 2011;69:963-974
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