Impact of Collateral Status on Neuroprotective Effect of Cyclosporine A in Acute Ischemic Stroke.
BACKGROUND
Neuroprotection for acute ischemic stroke remains an elusive goal. Intracranial collaterals may favor neuroprotective drugs delivery at the acute stage of ischemic stroke. A recent phase 2 study showed that cyclosporine A (CsA) reduced ischemic damage in patients with a proximal occlusion who experienced effective recanalization. Collateral flow may improve this benefit.


MATERIALS & METHODS
Collateral supply was assessed using dynamic susceptibility contrast MRI in 47 patients among the 110 patients from the original study and were graded in two groups: good collaterals and poor collaterals. Patients with good collaterals had significantly smaller initial infarct in both CsA group (p = 0.003) and controls (p = 0.016). Similarly, the final lesion volume was significantly lower in patients with good collaterals in both groups.


RESULTS
In patients with either good or poor collaterals CsA showed no additional benefit on ischemic lesion progression and final infarct size at day 30.


CONCLUSION
We failed to demonstrate any significant additional benefit of CsA in patients with good collateral circulation.
['Nighoghossian|Norbert|N|', 'Cornut|Lucie|L|', 'Amaz|Camille|C|', 'Eker|Omer|O|', 'Mewton|Nathan|N|', 'Ameli|Roxana|R|', 'Berner|Lise Prune|LP|', 'Cho|Tae Hee|TH|', 'Ovize|Michel|M|', 'Berthezene|Yves|Y|']
D000368:Aged D000369:Aged, 80 and over D001921:Brain D002545:Brain Ischemia D003097:Collateral Circulation D016572:Cyclosporine D005260:Female D006801:Humans D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D018696:Neuroprotective Agents D020521:Stroke D016896:Treatment Outcome
neuroprotection cyclosporine Acute ischemic stroke collateral flow MRI reperfusion.