Abstract
Background: Leptomeningeal collaterals preserve ischemic brain beyond an occluded artery until reperfusion is achieved. This systematic review and meta-analysis seeks to update current state of knowledge on the use of collateral imaging as a prognostic and patient selection tool in patients with acute ischemic stroke. Methods: We searched all published studies measuring collateral status in patients with acute ischemic stroke and its association with clinical outcome using MEDLINE, EMBASE and the Cochrane Systematic Review database between Jan 1951- May 2014. Imaging modality, collateral score type, time from stroke onset to evaluation and other parameters that assess study quality were collected. Association between collateral status and clinical outcome was estimated using random effects models. Meta-regression was then used to analyze heterogeneity. Results: Of 2,424 studies reviewed, 10 studies that fulfilled all inclusion/exclusion criteria, had all necessary data elements and reported adjusted point estimates were included in the final meta-analysis. Four studies used DSA to measure collaterals vs. 5 that used CTA and 1 dCTA; 6 studies included patients < 6 hours of symptom onset, 5 studies adjusted for reperfusion status while reporting point estimate while 5 studies used consensus reading. Pooled adjusted odds of good clinical outcome with good collateral status were 4.69 (95% CI 2.73-8.05) (Attached Figure 1). Only 36.3% of the variance in the pooled estimate is attributed to study heterogeneity (Q statistic p value=0.12). Meta-regression did not reveal any statistically significant difference in heterogeneity based on imaging modality (p=0.96), time from symptom onset to imaging (p=0.3), reperfusion status (p=0.82) or consensus reads (p=0.51). Begg’s test and funnel plot for small study effects suggests asymmetry (p<0.01). Conclusion: Collateral imaging is a reliable prognostic and patient selection tool in acute ischemic stroke.
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