J Clin Neurol.  2022 Sep;18(5):507-513. 10.3988/jcn.2022.18.5.507.

Collateral Flow in Magnetic Resonance Angiography: Prognostic Value for Vertebrobasilar Stenosis With Stroke Recurrence

• Yan L
• Yu Y
• Kang K
• Hou Z
• Wan M
• Fu W
• Cui R
• Wang Y
• Miao Z
• Lou X
• Ma N

• KMID: 2532694
• DOI: http://doi.org/10.3988/jcn.2022.18.5.507

Abstract

Background and Purpose
Intracranial vertebrobasilar atherosclerotic stenosis (IVBAS) is a major cause of posterior circulation stroke. Some patients suffer from stroke recurrence despite receiving medical treatment. This study aimed to determine the prognostic value of a new score for the posterior communicating artery and the P1 segment of the posterior cerebral artery (PCoA-P1) for predicting stroke recurrence in IVBAS.
Methods
We retrospectively enrolled patients with severe IVBAS (70%–99%). According to the number of stroke recurrences, patients were divided into no-recurrence, single-recurrence, and multiple-recurrences groups. We developed a new 5-point grading scale, with the PCoA-P1 score ranging from 0 to 4 based on magnetic resonance angiography, in which primary collaterals were dichotomized into good (2–4 points) and poor (0 or 1 point). Stroke recurrences after the index stroke were recorded. Patients who did not experience stroke recurrence were compared with those who experienced single or multiple stroke recurrences.
Results
From January 2012 to December 2019, 176 patients were enrolled, of which 116 (65.9%) had no stroke recurrence, 35 (19.9%) had a single stroke recurrence, and 25 (14.2%) had multiple stroke recurrences. Patients with single stroke recurrence (odds ratio [OR]= 4.134, 95% confidence interval [CI]=1.822–9.380, p=0.001) and multiple stroke recurrences (OR=6.894, 95% CI=2.489–19.092, p<0.001) were more likely to have poor primary collaterals than those with no stroke recurrence.
Conclusions
The new PCoA-P1 score appears to provide improve predictions of stroke recurrence in patients with IVBAS.

Keyword

posterior cerebral artery; ischemic stroke; magnetic resonance angiography; collateral circulation