• Janet Mei, Hamza A Salim, Dhairya A Lakhani, Aneri Balar, Basel Musmar, Nimer Adeeb, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z Hyson, Adam A Dmytriw, Adrien Guenego, Tobias D Faizy, Jeremy J Heit, Gregory W Albers, Victor C Urrutia, Raf Llinas, Elisabeth B Marsh, Argye E Hillis, Kambiz Nael, and Vivek S Yedavalli.
• Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
• J Neuroimaging. 2024 Jul 1; 34 (4): 424429424-429.

Background And PurposeDistal medium vessel occlusions (DMVOs) are a significant contributor to acute ischemic stroke (AIS), with collateral status (CS) playing a pivotal role in modulating ischemic damage progression. We aimed to explore baseline characteristics associated with CS in AIS-DMVO.MethodsThis retrospective analysis of a prospectively collected database enrolled 130 AIS-DMVO patients from two comprehensive stroke centers. Baseline characteristics, including patient demographics, admission National Institutes of Health Stroke Scale (NIHSS) score, admission Los Angeles Motor Scale (LAMS) score, and co-morbidities, including hypertension, hyperlipidemia, diabetes, coronary artery disease, atrial fibrillation, and history of transient ischemic attack or stroke, were collected. The analysis was dichotomized to good CS, reflected by hypoperfusion index ratio (HIR) <.3, versus poor CS, reflected by HIR ≥.3.ResultsGood CS was observed in 34% of the patients. As to the occluded location, 43.8% occurred in proximal M2, 16.9% in mid M2, 35.4% in more distal middle cerebral artery, and 3.8% in distal anterior cerebral artery. In multivariate logistic analysis, a lower NIHSS score and a lower LAMS score were both independently associated with a good CS (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.82-0.95, p < .001 and OR: 0.77, 95% CI: 0.62-0.96, p = .018, respectively). Patients with poor CS were more likely to manifest as moderate to severe stroke (29.1% vs. 4.5%, p < .001), while patients with good CS had a significantly higher chance of having a minor stroke clinically (40.9% vs. 12.8%, p < .001).ConclusionsCS remains an important determinant in the severity of AIS-DMVO. Collateral enhancement strategies may be a worthwhile pursuit in AIS-DMVO patients with more severe initial stroke presentation, which can be swiftly identified by the concise LAMS and serves as a proxy for underlying poor CS.© 2024 American Society of Neuroimaging.

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