Influence of Renal Function on Treatment Results after Stroke Thrombectomy

2017 ◽  
Vol 44 (5-6) ◽  
pp. 351-358 ◽  
Author(s):  
Mona Laible ◽  
Markus Alfred Möhlenbruch ◽  
Johannes Pfaff ◽  
Ekkehart Jenetzky ◽  
Peter Arthur Ringleb ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Multivariate Regression ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Poor Outcome ◽  
Increased Risk

Background: Renal dysfunction (RD) may be associated with poor outcome in ischemic stroke patients treated with mechanical thrombectomy (MT), but data concerning this important and emerging comorbidity do not exist so far. Here, we investigated the influence of RD on postprocedural intracerebral hemorrhage (ICH), clinical outcome, and mortality in a large prospectively collected cohort of acute ischemic stroke patients treated with MT. Methods: Consecutive patients with anterior-circulation stroke treated with MT between October 2010 and January 2016 were included. RD was defined as glomerular filtration rate (GFR) <60 mL/min/1.73 m2. In a prospective database, clinical characteristics were recorded and brain images were analyzed for the presence of ICH after treatment in all patients. Clinical outcome was assessed by the modified Rankin Scale (mRS) after 3 months. To evaluate associations between clinical factors and outcomes uni- and multivariate regression analyses were conducted. Results: In total, 505 patients fulfilled all inclusion criteria (female: 49.7%, mean age: 71.0 years). RD at admission was present in 20.2%. RD patients were older and had cardiovascular risk factors more often. Multivariate regression analysis after adjustment for age, stroke severity, diabetes, hypertension, GFR, previous stroke, MT alone, or additional thrombolysis and recanalization results revealed that lower GFR was not independently associated with poor outcome (mRS 3-6; OR 1.13, 95% CI 0.99-1.28; p = 0.072) or ICH. However, lower GFR at admission was associated with a higher risk of mortality (OR 1.15, 95% CI 1.01-1.31; p = 0.038). Compared to admission, GFR values were higher at discharge (mean: 77.9 vs. 80.8 mL/min/1.73 m2; p = 0.046). Conclusions: We did not find evidence for an association of lower GFR with an increased risk of poor outcome and ICH, but lower GFR was a determinant of 90-day mortality after endovascular stroke treatment. Our findings encourage also performing MT in this relevant subgroup of acute ischemic stroke patients.

Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients

2020 ◽  
Vol 13 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Noel van Horn ◽  
Helge Kniep ◽  
Hannes Leischner ◽  
Rosalie McDonough ◽  
Milani Deb-Chatterji ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Logistic Regression Analysis ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Poor Clinical Outcome ◽  
Poor Outcome

BackgroundIn patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.MethodsPatients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3–6 was defined as ‘poor outcome’. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.Results123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.ConclusionPoor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.

Microbleeds, Cerebral Hemorrhage, and Functional Outcome after Endovascular Thrombectomy

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011566
Author(s):  
Imad DERRAZ ◽  
Federico CAGNAZZO ◽  
Nicolas GAILLARD ◽  
Riccardo MORGANTI ◽  
Cyril DARGAZANLI ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Functional Outcome ◽  
Intravenous Thrombolysis ◽  
Stroke Severity ◽  
Confounding Factors ◽  
Poor Functional Outcome ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Poor Outcome ◽  
Increased Risk

Objective—To determine whether pre-treatment cerebral microbleeds (CMBs) presence and burden are correlated with an increased risk of intracranial hemorrhage (ICH) or poor functional outcome following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS).Methods—Consecutive patients treated by EVT for anterior circulation AIS were retrospectively analyzed. Experienced neuroradiologists blinded to functional outcomes rated CMBs on T2*-MRI using a validated scale. We investigated associations of CMB presence and burden with ICH and poor clinical outcome at 3 months (modified Rankin score >2).Results—Among 513 patients, 281 (54.8%) had a poor outcome and 89 (17.3%) had ≥1 CMBs. A total of 190 (37%) patients experienced ICH, in which 66 (12.9%) were symptomatic. CMB burden was associated with poor outcome in a univariable analysis (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.03–1.36 per 1-CMB increase; P=0.02), but significance was lost after adjustment for sex, age, stroke severity, hypertension, diabetes mellitus, atrial fibrillation, prior antithrombotic medication, intravenous thrombolysis, and reperfusion status (OR, 1.05; 95% CI, 0.92–1.20 per 1-CMB increase; P=0.50). Results remained nonsignificant when taking into account CMB location or presumed underlying pathogenesis. CMB presence, burden, location, nor presumed pathogenesis was independently correlated with ICH.Conclusions—Poor functional outcome or ICH were not correlated with CMB presence or burden on pre–EVT MRI after adjustment for confounding factors. Excluding such patients from reperfusion therapies is unwarranted.Classification of Evidence—This study provides Class II evidence that in patients with AIS undergoing EVT, after adjustment for confounding factors, the presence of CMBs is not significantly associated with clinical outcome or the risk of ICH.

scholarly journals New Thrombotic Events in Ischemic Stroke Patients with Elevated Factor VIII

Thrombosis ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Brittany M. Gouse ◽  
Amelia K. Boehme ◽  
Dominique J. Monlezun ◽  
James E. Siegler ◽  
Alex J. George ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Factor Viii ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Increased Risk ◽  
Baseline Characteristics

Background. Heightened levels of Factor VIII (FVIII) have been associated with both arterial and venous thrombosis. While elevated FVIII is common during acute ischemic stroke (AIS), whether elevated FVIII confers an increased risk for recurrent thrombotic events (RTEs) following AIS has not been previously explored. Methods. Consecutive AIS patients who presented to our center between July 2008 and September 2013 and had FVIII measured during admission were identified from our stroke registry. Baseline characteristics and the occurrence of RTE (recurrent or progressive ischemic stroke, DVT/PE, and MI) were compared in patients with and without elevated FVIII levels. Results. Of the 298 patients included, 203 (68.1%) had elevated FVIII levels. Patients with elevated FVIII had higher rates of any in-hospital RTE (18.7% versus 8.4%, P=0.0218). This association remained after adjustment for baseline stroke severity and etiology (OR 1.01, 95% CI 1.00–1.01, P=0.0013). Rates of major disability were also higher in patients who experienced a RTE (17.8% versus 3.2%, P<0.0001). Conclusion. A significantly higher frequency of in-hospital RTEs occurred in AIS patients with elevated FVIII. The occurrence of such events was associated with higher morbidity. Further study is indicated to evaluate whether FVIII is a candidate biomarker for increased risk of RTEs following AIS.

Thrombectomy in acute ischemic stroke: estimations of increasing demands

2016 ◽  
Vol 9 (9) ◽  
pp. 830-833 ◽  
Author(s):  
Åsa Kuntze Söderqvist ◽  
Tommy Andersson ◽  
Niaz Ahmed ◽  
Nils Wahlgren ◽  
Magnus Kaijser
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Artery Occlusion ◽  
University Hospital ◽  
Stroke Severity ◽  
Large Artery ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Stroke Registry ◽  
New Treatment

BackgroundNew recommendations for mechanical thrombectomy in acute ischemic stroke suggest that thrombectomy should be considered for eligible patients with a large artery occlusion in the anterior circulation within 6 hours of stroke onset. The resources are unevenly spread and, in order to be able to meet a potentially increased demand, we have estimated the future need for thrombectomy.MethodsThe new treatment recommendations are similar to those that have been in use at the Karolinska University Hospital since 2007. Using our local thrombectomy data (2009–2011), we calculated the proportion of thrombectomies performed at our hospital by level of stroke severity according to the National Institutes of Health Stroke Scale score (0–5, 6–11, 12–19, and 20–35). We then estimated the total number of potential thrombectomies expected in Sweden by extrapolating our treatment proportions to the rest of Sweden through the use of data from the Swedish National Stroke Registry.ResultsThe number of potential thrombectomies would have been more than five times higher (1268 estimated compared with 232 actually reported in the National Stroke Registry) if the new recommendations for thrombectomy in acute ischemic stroke had been implemented in 2013 (the year from which we had the most recent available data from the Swedish Stroke Registry).ConclusionsWhen the new recommendations are implemented broadly, there may be a substantial increase in demand for thrombectomies. Our study highlights the need for policymakers and healthcare professionals to prepare for the increasing demands for advanced endovascular stroke treatment.

scholarly journals Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients

2021 ◽  
Vol 11 (5) ◽  
pp. 612
Author(s):  
Minwoo Lee ◽  
Jae-Sung Lim ◽  
Yerim Kim ◽  
Ju Hun Lee ◽  
Chul-Ho Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Acute Ischemic Stroke ◽  
Sex Education ◽  
Cognitive Domain ◽  
P Value ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Post Stroke

Background: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated with post-stroke cognitive impairment (PSCI). Methods: We enrolled acute ischemic stroke patients whose cognitive functions were evaluated three months after a stroke using the Korean version of the vascular cognitive impairment harmonization standards neuropsychological protocol (K-VCIHS-NP). The development of PSCI was defined as having z-scores of less than −2 standard deviations in at least one cognitive domain. The participants were categorized into three groups according to the glycemic gap status: non-elevated (initial glucose − eAG ≤ 0 mg/dL), mildly elevated (0 mg/dL < initial glucose − eAG < 50 mg/dL), and severely elevated (50 mg/dL ≤ initial glucose − eAG). Results: A total of 301 patients were enrolled. The mean age was 63.1 years, and the median National Institute of Health Stroke Scale (NIHSS) score was two (IQR: 1–4). In total, 65 patients (21.6%) developed PSCI. In multiple logistic regression analyses, the severely elevated glycemic gap was a significant predictor for PSCI after adjusting for age, sex, education level, initial stroke severity, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and left hemispheric lesion (aOR: 3.65, p-value = 0.001). Patients in the severely elevated glycemic gap group showed significantly worse performance in the frontal and memory domains. Conclusions: In conclusion, our study demonstrated that an elevated glycemic gap was significantly associated with PSCI three months after a stroke, with preferential involvement of frontal and memory domain dysfunctions.

Abstract P679: Ankle-Brachial Index is Independently Associated With Functional Outcome After Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Moises C Dantas ◽  
Alice S Oliveira ◽  
Liz U Velloso ◽  
Marcio J Lucio ◽  
Milla D Pimenta ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Ankle Brachial Index ◽  
Lower Limbs ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Poor Outcome ◽  
Cerebrovascular Risk Factor ◽  
Increased Risk ◽  
Cerebrovascular Risk

Introduction: The ankle-brachial index (ABI) is the ratio between systolic blood pressure of the upper and lower limbs. A low ABI ( < 0.9) is associated with increased risk of cardiovascular and stroke outcomes. However, ABI relevance for functional outcomes is unknown. Objective: We aimed to investigate if low ABI is associated with functional outcome in stroke patients. Methods: Consecutive patients with imaging-confirmed ischemic stroke were recruited from a public hospital in Salvador, Brazil. Demographic and cerebrovascular risk factor data were collected prospectively. We used NIH stroke scale to quantify stroke severity and ABI was measured on admission. Patients were followed for 90 days and functional outcome was assessed by modified Rankin Scale (mRS). Poor outcome was defined as a mRS = 3 to 6. Logistic regression was used to adjust for potential confounders of poor outcome. Results: We recruited 376 patients with ischemic stroke between October 2018 and October 2019, mean age 64 +/- 13 years, 189 (49%) female. Median ABI was 1.06 (interquartile range - IQR 0.93 to 1.13). After 90 days, 209 (56%) patients had poor outcome. Low ABI was more frequent in patients with poor outcome (38% vs 18%, p=0.0001). After adjustment for age, sex and cerebrovascular risk factors, low ABI remained a significant predictor of poor outcome (odds ratio 2.10; 95% confidence interval 1.24 - 3.55, p=0.006). Conclusions: Low ABI is an independent predictor of poor outcome in acute stroke patients. Assessment of ABI on admission is clinically useful as a prognostic tool and should be more routinely implemented.

Abstract TP207: Pre-stroke Dementia is Associated With Poor Functional Outcome After Acute Ischemic Stroke: The Fukuoka Stroke Registry

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Yoshinobu Wakisaka ◽  
Ryu Matsuo ◽  
Junya Hata ◽  
Junya Kuroda ◽  
Tetsuro Ago ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Vessel Occlusion ◽  
Stroke Registry ◽  
Increased Risk

Introduction: With an aging population, an increased number of acute stroke patients with pre-stroke dementia is expected. Although both stroke and dementia are major cause of disability, the effect of pre-stroke dementia on functional outcome after stroke has been still on debate. Hypothesis: Pre-stroke dementia is associated with poor functional outcome after acute ischemic stroke. Methods: Of 9198 stroke patients registered in the Fukuoka Stroke Registry in Japan from June 2007 to May 2014, 3843 patients with first-ever ischemic stroke within 24h of onset, who had been functionally independent before the onset, were enrolled in this study (cardioembolism [n=926], large artery atherosclerosis [n=583], small vessel occlusion [n=1045], others [n=1289]). Pre-stroke dementia was defined as any type of dementia that was present prior to the stroke. For propensity score (PS)-matched analysis, 320 pairs of patients with and without pre-stroke dementia were also selected. Study outcome was poor functional outcome (modified Rankin Scale 3-6) at discharge. Results: In the total cohort, 330 (8.6%) had pre-stroke dementia. The age (80±8 vs 69±13, year, mean±SD, p<0.01), frequencies of female (46 vs 36, %, p<0.01) and cardioembolism (41 vs 23, %, p<0.01), and NIHSS score on admission (6 [3 - 12] vs 3 [1 - 6], median [interquartile], p<0.01) were higher in patients with pre-stroke dementia than those without the dementia. Poor functional outcome (62 vs 25, %, p<0.01) were more prevalent in patients with pre-stroke dementia than those without the dementia. Multivariable-adjusted analysis showed that pre-stroke dementia was significantly associated with increased risk for poor functional outcome (OR 2.3, 95% CI 1.7-3.2). There were no interactions between pre-stroke dementia and 4 variables (age, sex, stroke subtype, and initial stroke severity [NIHSS≤7 or NIHSS≥8]). In the PS-matched analysis, pre-stroke dementia was still associated with poor functional outcome (OR 4.3, 95%CI 2.1-8.8). Conclusions: Pre-stroke dementia was significantly associated with poor functional outcome at discharge in patients with acute ischemic stroke.

Abstract W P108: The Burden and Topographic Distribution of Intracranial Atherosclerosis Predict Stroke Recurrence: A Longitudinal Study of Acute Ischemic Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Byung-Su Kim ◽  
Gyeong-Moon Kim ◽  
Oh Young Bang ◽  
Kwang Ho Lee ◽  
Chin-Sang Chung
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Recurrence ◽  
Intracranial Atherosclerosis ◽  
Stroke Patients ◽  
Stroke Event ◽  
Anterior Circulation ◽  
Increased Risk ◽  
Ischemic Attack ◽  
Topographic Distribution

Introduction: To date, it remains unclear whether the burden and topographic distribution of intracranial atherosclerosis (ICAS) predict subsequent stroke event. Hypothesis: We assessed the hypothesis that the presence of advanced ICAS at the baseline is an independent biomarker to predict future stroke recurrence among acute ischemic stroke patients. Methods: A total of 446 consecutive patients with ischemic stroke or transient ischemic attack (TIA) were included in this study. Cox proportional regression model was used to examine the association between the burden and topographic distribution of ICAS and subsequent ischemic stroke or TIA. Using the MRA findings at the baseline, we classified patients into 3 groups by the number of ICAS: 1) none (n=277); 2) single (n=88); and 3) two or more (n=81), and into 4 groups by the distribution of ICAS: 1) none (n=277); 2) anterior circulation territory (n=89); 3) posterior circulation territory (n=48); and 4) both circulation territories (n=32), respectively. Results and Conclusions: The recurrence rate of ischemic stroke or TIA was 10.8% (n=48) over a median 4.6 years of follow-up. The presence of two or more ICAS (adjusted hazard ratio [HR]: 2.54, 95% CI: 1.31-4.92) and ICAS located in both circulation territories (HR: 3.27, 95% CI: 1.38-7.73) were independently associated with an increased risk of recurrence of ischemic stroke or TIA, after adjustment of vascular risk factors and secondary prevention medication. In conclusion, our findings suggest that advanced ICAS in acute ischemic stroke patients could be an independent predictor for recurrence of ischemic stroke or TIA.

Association of Non-Traditional Lipid Parameters with Hemorrhagic Transformation and Clinical Outcome After Thrombolysis in Ischemic Stroke Patients

2021 ◽  
Vol 17 ◽  
Author(s):  
Yun Luo ◽  
Jie Chen ◽  
Xiu-Li Yan ◽  
Hang Jin ◽  
Xin Sun ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Density Lipoprotein ◽  
Intravenous Thrombolysis ◽  
Roc Curves ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Poor Outcome ◽  
Increased Risk ◽  
Lipid Parameters

Objective: Recently, a few studies have shown that non-traditional lipid parameters are associated with the hemorrhagic transformation (HT) and the clinical outcome of ischemic stroke. However, the role of non-traditional lipid parameters in ischemic stroke patients treated with intravenous thrombolysis remains unclear. Thus, we aimed to assess the associations of non-traditional lipid parameters with HT and clinical outcome after thrombolysis in ischemic stroke patients. Methods: This study consecutively included 763 ischemic stroke patients treated with intravenous thrombolysis. Non-traditional lipid parameters included non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol to HDL-C ratio (TC/HDL-C), triglyceride to HDL-C ratio (TG/ HDL-C), and low-density lipoprotein cholesterol to HDL-C ratio (LDL-C/HDL-C). Receiver operating characteristic (ROC) curves and multivariate logistic regression analyses were used to investigate the associations between the four non-traditional lipid parameters and HT and poor outcome after thrombolysis. Results: Of 763 patients, 78 (10.2%) had HT and 281 (36.8%) had poor outcome. The ROC curves showed that the optimum cut-off points of the non-HDL-C, TC/HDL-C, TG/HDL-C, and LDL/HDL-C for predicting HT and poor outcome were 2.99 and 2.01, 4.05 and 3.66, 0.82 and 1.02, as well as 2.67 and 2.71, respectively. Multivariate logistic regression analyses showed that the TC/HDL-C <4.05 (adjusted odds ratio [OR]=1.727, 95% confidence interval [CI]: 1.008–2.960), TG/HDL-C <0.82 (adjusted OR=2.064, 95% CI: 1.241–3.432), and LDL/HDL-C <2.67 (adjusted OR=1.935, 95% CI: 1.070–3.501) were positively associated with the risk of HT, while the non-HDL-C <2.99 (adjusted OR=0.990, 95% CI: 0.583–1.680) was not related to the risk of HT. In addition, the non-HDL-C <2.01, TC/HDL-C <3.66, TG/HDL-C <1.02, and LDL/HDL-C <2.71 were associated with an increased risk of poor outcome, with adjusted ORs of 2.340 (95% CI: 1.150–4.764), 1.423 (95% CI: 1.025–1.977), 1.539 (95% CI: 1.102–2.151), and 1.608 (95% CI: 1.133–2.283). Conclusion: Low TC/HDL-C, TG/HDL-C, and LDL/HDL-C, but not non-HDL-C, were associated with an increased risk of HT after thrombolysis. In addition, low non-HDL-C, TC/HDL-C, TG/HDL-C, and LDL/HDL-C were associated with an increased risk of poor outcome in ischemic stroke patients with intravenous thrombolysis.

Prestroke statin use enhances collateralization in acute ischemic stroke patients

2020 ◽  
Vol 38 (4) ◽  
pp. 311-321
Author(s):  
Jiaying Zhu ◽  
Mengmeng Ma ◽  
Jinghuan Fang ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Statin Therapy ◽  
Cerebral Artery ◽  
Functional Outcomes ◽  
Collateral Circulation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

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