TY - JOUR
T1 - Peripheral Artery Disease in Acute Ischemic Stroke Patients Treated With Endovascular Thrombectomy; Results From the MR CLEAN Registry
AU - Pirson, France A.
AU - Hinsenveld, Wouter H.
AU - Staals, Julie
AU - de Ridder, Inger R.
AU - van Zwam, Wim H.
AU - Schreuder, Tobien H. C. M. L.
AU - Roos, Yvo B. W. E. M.
AU - Majoie, Charles B. L. M.
AU - van der Worp, H. Bart
AU - Uyttenboogaart, Maarten
AU - Lycklama a Nijeholt, Geert J.
AU - Schonewille, Wouter J.
AU - van Oostenbrugge, Robert J.
AU - MR CLEAN Registry Investigators
N1 - Funding Information:
Funding. The MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke) was partly funded by Stichting Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN), Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam University Medical Center.
Funding Information:
The MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke) was partly funded by Stichting Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN), Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam University Medical Center.
Publisher Copyright:
© Copyright © 2020 Pirson, Hinsenveld, Staals, de Ridder, van Zwam, Schreuder, Roos, Majoie, van der Worp, Uyttenboogaart, Lycklama à Nijeholt, Schonewille and van Oostenbrugge.
PY - 2020/10/7
Y1 - 2020/10/7
N2 - Background and Purpose: Though peripheral artery disease (PAD) is a well-known risk factor for ischemic events, better outcomes have been described in acute ischemic stroke patients with co-existing PAD. This paradoxical association has been attributed to remote ischemic preconditioning (RIPC) and might be related to better collateral blood flow. The aim of this study is to compare outcomes after endovascular thrombectomy (EVT) in acute stroke patients with and without PAD and to assess the relation between PAD and collateral grades.Methods: We analyzed acute ischemic stroke patients treated with EVT for an anterior circulation large artery occlusion, included in the Dutch, prospective, multicenter MR CLEAN Registry between March 2014 and November 2017. Collaterals were scored on CT angiography, using a 4-point collateral score. We used logistic regression analysis to estimate the association of PAD with collateral grades and functional outcome, assessed with the modified Rankin Scale (mRS) at 90 days. Safety outcomes included mortality at 90 days, symptomatic intracranial hemorrhage, and stroke progression.Results: We included 2,765 patients for analysis, of whom 254 (9.2%) had PAD. After adjustment for potential confounders, multivariable regression analysis showed no association of PAD with functional outcome [mRS cOR 0.90 (95% CI, 0.7-1.2)], collateral grades (cOR 0.85, 95% CI 0.7-1.1), or safety outcomes.Conclusion: In the absence of an association between the presence of PAD and collateral scores or outcomes after EVT, it may be questioned whether PAD leads to RIPC in patients with acute ischemic stroke due to large vessel occlusion.
AB - Background and Purpose: Though peripheral artery disease (PAD) is a well-known risk factor for ischemic events, better outcomes have been described in acute ischemic stroke patients with co-existing PAD. This paradoxical association has been attributed to remote ischemic preconditioning (RIPC) and might be related to better collateral blood flow. The aim of this study is to compare outcomes after endovascular thrombectomy (EVT) in acute stroke patients with and without PAD and to assess the relation between PAD and collateral grades.Methods: We analyzed acute ischemic stroke patients treated with EVT for an anterior circulation large artery occlusion, included in the Dutch, prospective, multicenter MR CLEAN Registry between March 2014 and November 2017. Collaterals were scored on CT angiography, using a 4-point collateral score. We used logistic regression analysis to estimate the association of PAD with collateral grades and functional outcome, assessed with the modified Rankin Scale (mRS) at 90 days. Safety outcomes included mortality at 90 days, symptomatic intracranial hemorrhage, and stroke progression.Results: We included 2,765 patients for analysis, of whom 254 (9.2%) had PAD. After adjustment for potential confounders, multivariable regression analysis showed no association of PAD with functional outcome [mRS cOR 0.90 (95% CI, 0.7-1.2)], collateral grades (cOR 0.85, 95% CI 0.7-1.1), or safety outcomes.Conclusion: In the absence of an association between the presence of PAD and collateral scores or outcomes after EVT, it may be questioned whether PAD leads to RIPC in patients with acute ischemic stroke due to large vessel occlusion.
KW - peripheral artery disease
KW - acute ischemic stroke
KW - ischemic preconditioning
KW - endovascular treatment
KW - functional outcome
KW - ANKLE-BRACHIAL INDEX
KW - CT ANGIOGRAPHY
KW - CEREBRAL INFARCTION
KW - VASCULAR-DISEASE
KW - OUTCOMES
KW - ASSOCIATION
KW - CIRCULATION
KW - COLLATERALS
KW - PREDICTOR
KW - ATTACK
U2 - 10.3389/fneur.2020.560300
DO - 10.3389/fneur.2020.560300
M3 - Article
C2 - 33133007
SN - 1664-2295
VL - 11
JO - Frontiers in Neurology
JF - Frontiers in Neurology
M1 - 560300
ER -