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Original research
Leukoaraiosis and collateral blood flow in stroke patients with anterior circulation large vessel occlusion
  1. Ian Mark1,
  2. Seyed Mohammad Seyedsaadat1,
  3. John C Benson1,
  4. David F Kallmes1,2,
  5. Alejandro A Rabinstein3,
  6. Waleed Brinjikji1,2
  1. 1 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Ian Mark, Department of Radiology, Mayo Clinic Minnesota, Rochester, MN 55905, USA; Mark.Ian{at}


Background Leukoaraiosis and collateral blood flow are processes that involve small vessels, the former related to flow within the deep perforating arterioles and the latter involving the small, cortical pial-pial connections, both of which are independently used to predict cerebrovascular events and treatment outcomes. The aim of this study was to investigate their relationship to each other.

Methods We retrospectively reviewed patients who underwent mechanical thrombectomy for stroke with pre-procedural CT imaging within 24 hours of the onset of symptoms. Leukoaraiosis was graded by the total Fazekas score on non-contrast CT, periventricular white matter (PVWM) and deep white matter (DWM) scores, both ranging from 0 to 3. Collateral cerebral blood flow was measured by the American Society of Interventional and Therapeutic Radiology/Society of Interventional Radiology (ASITN/SIR) collateral scale.

Results 178 patients were included with a mean age of 67.6±14.8 years. We found an inverse relationship between total Fazekas score and collateral flow (p<0.0001). Among patients with good collaterals, 75.1% had total Fazekas scores of 0–2, compared with 36.6% of patients with moderate collaterals and 32.7% of patients with poor collaterals with total Fazekas scores of 0–2. Mean Fazekas scores were 1.6±1.5, 3.1±1.5 and 3.4±1.6 for good, moderate and poor collaterals, respectively (p<0.0001). On multivariate analysis, total Fazekas score was the only variable independently associated with collateral status (p<0.0001).

Conclusions Increasing severity of leukoaraiosis is associated with poor collateral grade among ischemic stroke patients with anterior circulation large vessel occlusion. These findings suggest that leukoaraiosis may be a marker for global cerebrovascular dysfunction.

  • brain
  • CT angiography
  • stroke
  • blood flow
  • angiography

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  • Contributors ITM analyzed the data, and drafted and revised the paper. SMS collected the data. JCB analyzed the data and revised the draft paper. DFK and AAR revised the draft paper. WB designed the study, monitored the data collection, analyzed the paper, and revised the paper. He is the guarantor.

  • Funding This work was supported by the American Heart Association, grant number 19POST34381067 awarded to SMS.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.