Intracranial carotid artery calcification subtype and collaterals in patients undergoing endovascular thrombectomy

S.P.R. Luijten; S.C. van der Donk; K.C.J. Compagne; L.S.F. Yo; M.E.S. Sprengers; C.B.L.M. Majoie; Y.B.W.E.M. Roos; W.H. van Zwam; R. van Oostenbrugge; D.W.J. Dippel; A. van der Lugt; B. Roozenbeek; D. Bos; MR CLEAN Registry Investigators

doi:10.1016/j.atherosclerosis.2021.10.005

Intracranial carotid artery calcification subtype and collaterals in patients undergoing endovascular thrombectomy

S.P.R. Luijten, S.C. van der Donk, K.C.J. Compagne, L.S.F. Yo, M.E.S. Sprengers, C.B.L.M. Majoie, Y.B.W.E.M. Roos, W.H. van Zwam, R. van Oostenbrugge, D.W.J. Dippel, A. van der Lugt, B. Roozenbeek, D. Bos^*, MR CLEAN Registry Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background and aims: Distinct subtypes of intracranial carotid artery calcification (ICAC) have been found (i.e., medial and intimal), which may differentially be associated with the formation of collaterals. We investigated the association of ICAC subtype with collateral status in patients undergoing endovascular thrombectomy (EVT) for ischemic stroke. We further investigated whether ICAC subtype modified the association between collateral status and functional outcome.Methods: We used data from 2701 patients with ischemic stroke undergoing EVT. Presence and subtype of ICAC were assessed on baseline non-contrast CT. Collateral status was assessed on baseline CT angiography using a visual scale from 0 (absent) to 3 (good). We investigated the association of ICAC subtype with collateral status using ordinal and binary logistic regression. Next, we assessed whether ICAC subtype modified the association between collateral status and functional outcome (modified Rankin Scale, 0-6).Results: Compared to patients without ICAC, we found no association of intimal or medial ICAC with collateral status (ordinal variable). When collateral grades were dichotomized (3 versus 0-2), we found that intimal ICAC was significantly associated with good collaterals in comparison to patients without ICAC (aOR, 1.41 [95% CI:1.06-1.89]) or with medial ICAC (aOR, 1.50 [95%CI:1.14-1.97]). The association between higher collateral grade and better functional outcome was significantly modified by ICAC subtype (p for interaction = 0.01).Conclusions: Patients with intimal ICAC are more likely to have good collaterals and benefit more from an extensive collateral circulation in terms of functional outcome after EVT.

Original language	English
Pages (from-to)	1-6
Number of pages	6
Journal	Atherosclerosis
Volume	337
DOIs	https://doi.org/10.1016/j.atherosclerosis.2021.10.005
Publication status	Published - 1 Nov 2021

Keywords

Intracranial carotid artery calcification
Ischemic stroke
Endovascular thrombectomy
Collateral status
RISK-FACTORS
STROKE
CIRCULATION
ANGIOGRAPHY
STIFFNESS
VESSELS
GROWTH
SCORE

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Luijten, S. P. R., van der Donk, S. C., Compagne, K. C. J., Yo, L. S. F., Sprengers, M. E. S., Majoie, C. B. L. M., Roos, Y. B. W. E. M., van Zwam, W. H., van Oostenbrugge, R., Dippel, D. W. J., van der Lugt, A., Roozenbeek, B., Bos, D., & MR CLEAN Registry Investigators (2021). Intracranial carotid artery calcification subtype and collaterals in patients undergoing endovascular thrombectomy. Atherosclerosis, 337, 1-6. https://doi.org/10.1016/j.atherosclerosis.2021.10.005

@article{19018b9b977a4309aa0468603396f29a,

title = "Intracranial carotid artery calcification subtype and collaterals in patients undergoing endovascular thrombectomy",

abstract = "Background and aims: Distinct subtypes of intracranial carotid artery calcification (ICAC) have been found (i.e., medial and intimal), which may differentially be associated with the formation of collaterals. We investigated the association of ICAC subtype with collateral status in patients undergoing endovascular thrombectomy (EVT) for ischemic stroke. We further investigated whether ICAC subtype modified the association between collateral status and functional outcome.Methods: We used data from 2701 patients with ischemic stroke undergoing EVT. Presence and subtype of ICAC were assessed on baseline non-contrast CT. Collateral status was assessed on baseline CT angiography using a visual scale from 0 (absent) to 3 (good). We investigated the association of ICAC subtype with collateral status using ordinal and binary logistic regression. Next, we assessed whether ICAC subtype modified the association between collateral status and functional outcome (modified Rankin Scale, 0-6).Results: Compared to patients without ICAC, we found no association of intimal or medial ICAC with collateral status (ordinal variable). When collateral grades were dichotomized (3 versus 0-2), we found that intimal ICAC was significantly associated with good collaterals in comparison to patients without ICAC (aOR, 1.41 [95% CI:1.06-1.89]) or with medial ICAC (aOR, 1.50 [95%CI:1.14-1.97]). The association between higher collateral grade and better functional outcome was significantly modified by ICAC subtype (p for interaction = 0.01).Conclusions: Patients with intimal ICAC are more likely to have good collaterals and benefit more from an extensive collateral circulation in terms of functional outcome after EVT.",

keywords = "Intracranial carotid artery calcification, Ischemic stroke, Endovascular thrombectomy, Collateral status, RISK-FACTORS, STROKE, CIRCULATION, ANGIOGRAPHY, STIFFNESS, VESSELS, GROWTH, SCORE",

author = "S.P.R. Luijten and {van der Donk}, S.C. and K.C.J. Compagne and L.S.F. Yo and M.E.S. Sprengers and C.B.L.M. Majoie and Y.B.W.E.M. Roos and {van Zwam}, W.H. and {van Oostenbrugge}, R. and D.W.J. Dippel and {van der Lugt}, A. and B. Roozenbeek and D. Bos and {MR CLEAN Registry Investigators}",

note = "Funding Information: Dr Majoie reports that he is a shareholder of NICO.LAB and grants from CVON/Dutch Heart Foundation, European Commission, TWIN Foundation, and Stryker, all paid to institution. Dr Roos reports that he is a shareholder of NICO.LAB. Dr van Zwam reports grants from Stryker and Cerenovus, all paid to institution. Dr Dippel reports grants from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Researce and Development, Health Holland Top Sector Life Sciences and Health, and grants from Penumbra, Stryker, Medtronic, Thrombolytic Science, LLC, and Cerenovus, all paid to institution. Dr van der Lugt reports grants from Penumbra, Stryker, Cerenovus, and Medtronic, all paid to institution. The other authors report no disclosures. Funding Information: The MR CLEAN Registry was partly funded by TWIN Foundation , Erasmus MC University Medical Center , Maastricht University Medical Center , and Amsterdam University Medical Center . Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2021",

month = nov,

day = "1",

doi = "10.1016/j.atherosclerosis.2021.10.005",

language = "English",

volume = "337",

pages = "1--6",

journal = "Atherosclerosis",

issn = "0021-9150",

publisher = "Elsevier Ireland Ltd",

}

Luijten, SPR, van der Donk, SC, Compagne, KCJ, Yo, LSF, Sprengers, MES, Majoie, CBLM, Roos, YBWEM, van Zwam, WH , van Oostenbrugge, R, Dippel, DWJ, van der Lugt, A, Roozenbeek, B, Bos, D & MR CLEAN Registry Investigators 2021, 'Intracranial carotid artery calcification subtype and collaterals in patients undergoing endovascular thrombectomy', Atherosclerosis, vol. 337, pp. 1-6. https://doi.org/10.1016/j.atherosclerosis.2021.10.005

TY - JOUR

T1 - Intracranial carotid artery calcification subtype and collaterals in patients undergoing endovascular thrombectomy

AU - Luijten, S.P.R.

AU - van der Donk, S.C.

AU - Compagne, K.C.J.

AU - Yo, L.S.F.

AU - Sprengers, M.E.S.

AU - Majoie, C.B.L.M.

AU - Roos, Y.B.W.E.M.

AU - van Zwam, W.H.

AU - van Oostenbrugge, R.

AU - Dippel, D.W.J.

AU - van der Lugt, A.

AU - Roozenbeek, B.

AU - Bos, D.

AU - MR CLEAN Registry Investigators

N1 - Funding Information: Dr Majoie reports that he is a shareholder of NICO.LAB and grants from CVON/Dutch Heart Foundation, European Commission, TWIN Foundation, and Stryker, all paid to institution. Dr Roos reports that he is a shareholder of NICO.LAB. Dr van Zwam reports grants from Stryker and Cerenovus, all paid to institution. Dr Dippel reports grants from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Researce and Development, Health Holland Top Sector Life Sciences and Health, and grants from Penumbra, Stryker, Medtronic, Thrombolytic Science, LLC, and Cerenovus, all paid to institution. Dr van der Lugt reports grants from Penumbra, Stryker, Cerenovus, and Medtronic, all paid to institution. The other authors report no disclosures. Funding Information: The MR CLEAN Registry was partly funded by TWIN Foundation , Erasmus MC University Medical Center , Maastricht University Medical Center , and Amsterdam University Medical Center . Publisher Copyright: © 2021 The Authors

PY - 2021/11/1

Y1 - 2021/11/1

N2 - Background and aims: Distinct subtypes of intracranial carotid artery calcification (ICAC) have been found (i.e., medial and intimal), which may differentially be associated with the formation of collaterals. We investigated the association of ICAC subtype with collateral status in patients undergoing endovascular thrombectomy (EVT) for ischemic stroke. We further investigated whether ICAC subtype modified the association between collateral status and functional outcome.Methods: We used data from 2701 patients with ischemic stroke undergoing EVT. Presence and subtype of ICAC were assessed on baseline non-contrast CT. Collateral status was assessed on baseline CT angiography using a visual scale from 0 (absent) to 3 (good). We investigated the association of ICAC subtype with collateral status using ordinal and binary logistic regression. Next, we assessed whether ICAC subtype modified the association between collateral status and functional outcome (modified Rankin Scale, 0-6).Results: Compared to patients without ICAC, we found no association of intimal or medial ICAC with collateral status (ordinal variable). When collateral grades were dichotomized (3 versus 0-2), we found that intimal ICAC was significantly associated with good collaterals in comparison to patients without ICAC (aOR, 1.41 [95% CI:1.06-1.89]) or with medial ICAC (aOR, 1.50 [95%CI:1.14-1.97]). The association between higher collateral grade and better functional outcome was significantly modified by ICAC subtype (p for interaction = 0.01).Conclusions: Patients with intimal ICAC are more likely to have good collaterals and benefit more from an extensive collateral circulation in terms of functional outcome after EVT.

AB - Background and aims: Distinct subtypes of intracranial carotid artery calcification (ICAC) have been found (i.e., medial and intimal), which may differentially be associated with the formation of collaterals. We investigated the association of ICAC subtype with collateral status in patients undergoing endovascular thrombectomy (EVT) for ischemic stroke. We further investigated whether ICAC subtype modified the association between collateral status and functional outcome.Methods: We used data from 2701 patients with ischemic stroke undergoing EVT. Presence and subtype of ICAC were assessed on baseline non-contrast CT. Collateral status was assessed on baseline CT angiography using a visual scale from 0 (absent) to 3 (good). We investigated the association of ICAC subtype with collateral status using ordinal and binary logistic regression. Next, we assessed whether ICAC subtype modified the association between collateral status and functional outcome (modified Rankin Scale, 0-6).Results: Compared to patients without ICAC, we found no association of intimal or medial ICAC with collateral status (ordinal variable). When collateral grades were dichotomized (3 versus 0-2), we found that intimal ICAC was significantly associated with good collaterals in comparison to patients without ICAC (aOR, 1.41 [95% CI:1.06-1.89]) or with medial ICAC (aOR, 1.50 [95%CI:1.14-1.97]). The association between higher collateral grade and better functional outcome was significantly modified by ICAC subtype (p for interaction = 0.01).Conclusions: Patients with intimal ICAC are more likely to have good collaterals and benefit more from an extensive collateral circulation in terms of functional outcome after EVT.

KW - Intracranial carotid artery calcification

KW - Ischemic stroke

KW - Endovascular thrombectomy

KW - Collateral status

KW - RISK-FACTORS

KW - STROKE

KW - CIRCULATION

KW - ANGIOGRAPHY

KW - STIFFNESS

KW - VESSELS

KW - GROWTH

KW - SCORE

U2 - 10.1016/j.atherosclerosis.2021.10.005

DO - 10.1016/j.atherosclerosis.2021.10.005

M3 - Article

C2 - 34662837

SN - 0021-9150

VL - 337

SP - 1

EP - 6

JO - Atherosclerosis

JF - Atherosclerosis

ER -