Factors Associated with Leptomeningeal Collaterals and Their Impact on Functional Outcomes in Anterior Circulation Acute Ischemic Stroke

Background and Objectives: Leptomeningeal collaterals are essential for maintaining cerebral perfusion during acute large vessel occlusion (LVO) and are predictive of favorable outcomes in stroke patients. However, the factors influencing baseline collateral status are not well understood. We aimed to identify factors predicting poor baseline collateral status and unfavorable 3-month outcomes in acute ischemic stroke (AIS) patients with LVO in the anterior circulation in the Indian subcontinent. Methods: We retrospectively enrolled 239 patients who underwent computed tomography angiography within 24 hours of acute ischemic stroke. Patient demographics, vascular risk factors, baseline stroke severity, etiology, and 3-month functional outcomes were collected. Results: The mean age was 59.5 ± 13.5 years; 152 (64%) patients were males, and the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 15. Bivariate analysis showed that male sex (77% vs. 58%, P = 0.004), absence of valvular disease (92% vs. 82%), lower clot burden score (CBS) (32% vs. 16%, P = 0.003), and renal dysfunction (11% vs. 3%, P = 0.01) were associated with poor collateral status. Logistic regression identified renal dysfunction (odds ratio [OR] 3.9; 95% confidence interval [CI], 1.2–14.68; P = 0.031) and lower CBS (OR, 0.40; 95% CI, 0.23–0.93; P = 0.030) as independently associated with poor collateral status. Poor 3-month outcomes were associated with older age (OR, 1.96; 95% CI, 1.05–3.68; P = 0.034), large vessel atherosclerosis (OR, 2.66; 95% CI, 1.27–5.56; P = 0.009), and poor collateral status (OR, 2.35; 95% CI, 1.18–4.66; P = 0.014). Conclusions: Lower CBS and renal dysfunction were associated with poor collateral status at baseline in AIS patients with LVO. Advanced age, large vessel atherosclerosis, poor collateral status, and greater stroke severity predicted poor functional outcomes at 3 months.