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
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.