The Association Between Leptomeningeal Anastomoses And Cerebral Infarction In Patients With Middle Cerebral Artery Stenosis

Objective To study the association between collateral circulation of leptomeningeal anastomosis(LMA)and cerebral infarction in patients with middle cerebral artery(MCA)M1-segment stenosis.Method Retrospectively recruited 106 patients with unilateral M1-segment stenosis of MCA were divided into two groups: 60 patients with cerebral infarction and 46 patients without.The general and clinical data including age,sex,stroke risk factors,previous stroke history,the baseline blood pressure,body mass index,relevant blood tests were recorded.Laterality of posterior cerebral artery(PCA)and anterior cerebral artery(ACA)was graded with 3D-TOF magnetic resonance angiography(MRA).ACA and PCA laterality was assessed by the presence of one or more segmental extents.The sum of laterality of ACA and PCA scores represented LMA compensatory state,according to which the infarction group were further divided into LMA-1(no compensation),LMA-2(compensation)and LMA-3(good compensation)group.In this study,stenosis rate ≥50% was defined as vascular stenosis with grade 1: 50 ~ 69% for moderate stenosis,grade 2: 70 ~ 99% for severe stenosis and grade 3: occlusion.The imaging data including presence of anterior communicating artery,ACA and PCA laterality scores,LMA compensation grades,lacunar infarction scores,leukoaraiosis grades and incidence of intracranial arterial stenosis were recorded.The general data,clinical and imaging data of two groups of patients with cerebral infarction and non-cerebral infarction were statistically analyzed to explore the influencing factors of cerebral infarction.The National Institutes of Health Stroke Scale(NIHSS)scores were recorded at admission and discharge and when the NIHSS scores was highest in groups of LMA-1,LMA-2 and LMA-3.Cerebral infarction pattern was assessed with Diffusion-weighted imaging(DWI).We compared the relationship between LMA compensation status and NIHSS scores as well as infarction pattern in patients with cerebral infarction.Results Comparing the general and clinical data of patients with cerebral infarction and those without,we found that the difference of age(63.05 ± 10.95 years vs 68.98 ± 10.28 years,P=0.005)as significant.There was no significant difference in gender,stroke risk factors,previous stroke history,baseline blood pressure,body mass index,and related blood tests(P> 0.05).Comparing the imaging data of patients with and without cerebral infarction,there was significant difference in the laterality of ACA scores [2.00(1.00~2.00)vs 2.00(2.00~3.00),P=0.003] and MCA stenosis grades [2.00(2.00~3.00)vs 2.00(1.00~3.00)grade,P=0.027].There was no significant difference between the two groups in the presence of anterior communicating artery,laterality of PCA scores,LMA compensation grades,lacunar infarction scores and leukoaraiosis grades(P> 0.05).There was no difference between the two groups in the incidence of basilar artery,ipsilateral vertebral artery,contralateral vertebral artery,ipsilateral ACA and ipsilateral PCA stenosis(P> 0.05).Logistic regression analysis showed the patients with cerebral infarction had younger age(OR= 0.935,95% CI: 0.889~0.983,P=0.009),the lower laterality of ACA scores(OR= 0.337,95% CI: 0.118~0.959,P=0.041)and more severe stenosis of MCA(OR= 2.146,95% CI: 1.150~4.007,P=0.016)than those without.There was significant difference in NIHSS scores at admission [5.00(2.75~8.00)vs 3.00(1.00~5.00)vs 2.00(0.50~4.00)scores] among patients of LMA-1,LMA-2 and LMA-3.Moreover,the degree of LMA compensation status was negatively correlated with NIHSS scores at admission(rs =-0.322,P=0.042).There was significant difference in NIHSS scores at admission between LMA-1 and LMA-3 group [5.00(2.75~8.00)vs 2.00(0.50~4.00),P=0.020].There was no significant difference in NIHSS scores at admission between LMA-1 and LMA-2 group,between LMA-2 and LMA-3 group(P1,2=0.061,P2,3=0.312).There was no significant difference in highest NIHSS scores and NIHSS scores at discharge among the three groups(P>0.05).In 60 patients with infarction,there were 25(41.67%)cases of perforating artery infarction pattern,25(41.67)border-zone infarction pattern,4(6.66%)pial infarction pattern and 6(10.00%)large infarction pattern.There was no significant difference in cerebral infarction pattern among patients with LMA-1,LMA-2 and LMA-3(P=0.339).Conclusion In patients with MCA M1-segment stenosis,the compensation status of ACA-MCA collateral circulation was worse in patients with cerebral infarction than those without.The degree of compensation status of LMA was correlated with neurological deficit.The degree of compensation status of LMA may not be related to the pattern of cerebral infarction.