TY - JOUR
T1 - Impact of single phase CT angiography collateral status on functional outcome over time
T2 - results from the MR CLEAN Registry
AU - Jansen, Ivo G. H.
AU - Mulder, Maxim J. H. L.
AU - Goldhoorn, Robert-Jan B.
AU - Boers, Anna M. M.
AU - van Es, Adriaan C. G. M.
AU - Yo, Lonneke S. F.
AU - Hofmeijer, Jeannette
AU - Martens, Jasper M.
AU - van Walderveen, Marianne A. A.
AU - van der Kallen, Bas F. W.
AU - Jenniskens, Sjoerd F. M.
AU - Treurniet, Kilian M.
AU - Marqueriny, Henk A.
AU - Sprengers, Marieke E. S.
AU - Schonewille, Wouter J.
AU - Bot, Joost
AU - Lycklama A Nijeholt, Geert J.
AU - Lingsma, Hester F.
AU - Liebeskind, David S.
AU - Boiten, Jelis
AU - Vos, Jan-Albert
AU - Roos, Yvo B. W. E. M.
AU - van Oostenbrugge, Robert J.
AU - van der Lugt, Aad
AU - van Zwam, Wim H.
AU - Dippel, Diederik W. J.
AU - van den Wijngaard, Ido R.
AU - Majoie, Charles B. L. M.
AU - Coutinho, Jonathan M.
AU - Wermern, Marieke J. H.
AU - Staals, Julie
AU - Roozenbeek, Bob
AU - Emmer, Bart J.
AU - de Bruijn, Sebastiaan F.
AU - van Dijk, Lukas C.
AU - van der Worp, H. Bart
AU - Lo, Rob H.
AU - van Dijk, Ewoud J.
AU - Boogaarts, Hieronymus D.
AU - de Kort, Paul L. M.
AU - Peluso, Jo J. P.
AU - van den Berg, Jan S. P.
AU - van Hasselt, Boudewijn A. A. M.
AU - Aerden, Leo A. M.
AU - Dallinga, Rene J.
AU - Uyttenboogaart, Maarten
AU - Eshghi, Omid
AU - Schreuder, Tobien H. C. M. L.
AU - Heijboer, Roel J. J.
AU - Groot, P. F. C.
AU - MR CLEAN Registry Investigators
PY - 2019/9
Y1 - 2019/9
N2 - Background Collateral status modified the effect of endovascular treatment (EVT) for stroke in several randomized trials. We assessed the association between collaterals and functional outcome in EVT treated patients and investigated if this association is time dependent.Methods We included consecutive patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) Registry (March 2014-June 2016) with an anterior circulation large vessel occlusion undergoing EVT. Functional outcome was measured on the modified Rankin Scale (mRS) at 90 days. We investigated the association between collaterals and mRS in the MR CLEAN Registry with ordinal logistic regression and if this association was time dependent with an interaction term. Additionally, we determined modification of EVT effect by collaterals compared with MR CLEAN controls, and also investigated if this was time dependent with multiplicative interaction terms.Results 1412 patients were analyzed. Functional independence (mRS score of 0-2) was achieved in 13% of patients with grade 0 collaterals, in 27% with grade 1, in 46% with grade 2, and in 53% with grade 3. Collaterals were significantly associated with mRS (adjusted common OR 1.5 (95% CI 1.4 to 1.7)) and significantly modified EVT benefit (P=0.04). None of the effects were time dependent. Better collaterals corresponded to lower mortality (PConclusion In routine clinical practice, better collateral status is associated with better functional outcome and greater treatment benefit in EVT treated acute ischemic stroke patients, independent of time to treatment. Within the 6 hour time window, a substantial proportion of patients with absent and poor collaterals can still achieve functional independence.
AB - Background Collateral status modified the effect of endovascular treatment (EVT) for stroke in several randomized trials. We assessed the association between collaterals and functional outcome in EVT treated patients and investigated if this association is time dependent.Methods We included consecutive patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) Registry (March 2014-June 2016) with an anterior circulation large vessel occlusion undergoing EVT. Functional outcome was measured on the modified Rankin Scale (mRS) at 90 days. We investigated the association between collaterals and mRS in the MR CLEAN Registry with ordinal logistic regression and if this association was time dependent with an interaction term. Additionally, we determined modification of EVT effect by collaterals compared with MR CLEAN controls, and also investigated if this was time dependent with multiplicative interaction terms.Results 1412 patients were analyzed. Functional independence (mRS score of 0-2) was achieved in 13% of patients with grade 0 collaterals, in 27% with grade 1, in 46% with grade 2, and in 53% with grade 3. Collaterals were significantly associated with mRS (adjusted common OR 1.5 (95% CI 1.4 to 1.7)) and significantly modified EVT benefit (P=0.04). None of the effects were time dependent. Better collaterals corresponded to lower mortality (PConclusion In routine clinical practice, better collateral status is associated with better functional outcome and greater treatment benefit in EVT treated acute ischemic stroke patients, independent of time to treatment. Within the 6 hour time window, a substantial proportion of patients with absent and poor collaterals can still achieve functional independence.
KW - COMPUTED TOMOGRAPHIC ANGIOGRAPHY
KW - LEPTOMENINGEAL COLLATERALS
KW - ENDOVASCULAR TREATMENT
KW - STROKE
KW - REPERFUSION
KW - SCORE
KW - MANAGEMENT
KW - PREDICTOR
KW - THERAPY
U2 - 10.1136/neurintsurg-2018-014619
DO - 10.1136/neurintsurg-2018-014619
M3 - Article
C2 - 30777890
VL - 11
SP - 866
EP - 873
JO - Journal of Neurointerventional Surgery
JF - Journal of Neurointerventional Surgery
SN - 1759-8478
IS - 9
ER -