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Impact of Collateral Status on Neuroprotective Effect of Cyclosporine A in Acute Ischemic Stroke

[ Vol. 16 , Issue. 2 ]

Author(s):

Norbert Nighoghossian*, Lucie Cornut, Camille Amaz, Omer Eker, Nathan Mewton, Roxana Ameli, Lise Prune Berner, Tae Hee Cho, Michel Ovize and Yves Berthezene   Pages 173 - 177 ( 5 )

Abstract:


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.

Keywords:

Acute ischemic stroke, collateral flow, MRI, cyclosporine, reperfusion, neuroprotection.

Affiliation:

Department of Stroke Medicine, University Lyon 1, Hospices Civils de Lyon, Lyon, Department of Neuroradiology, University Lyon 1, CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, Department of Cardiology, Clinical Investigation Center, Universite Lyon 1, Lyon, Department of Neuroradiology, University Lyon 1, CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, Department of Cardiology, Clinical Investigation Center, Universite Lyon 1, Lyon, Department of Neuroradiology, University Lyon 1, CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, Department of Neuroradiology, University Lyon 1, CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, Department of Stroke Medicine, University Lyon 1, Hospices Civils de Lyon, Lyon, Department of Cardiology, Clinical Investigation Center, Universite Lyon 1, Lyon, Department of Neuroradiology, University Lyon 1, CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon



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