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Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry.

Abstract：

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 (P<0.001), but not to lower rates of symptomatic intracranial hemorrhage (P=0.14). CONCLUSION: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.

journal_name

J Neurointerv Surg

journal_title

Journal of neurointerventional surgery

authors

Jansen IG,Mulder MJ,Goldhoorn RB,Boers AM,van Es AC,Yo LS,Hofmeijer J,Martens JM,van Walderveen MA,van der Kallen BF,Jenniskens SF,Treurniet KM,Marquering HA,Sprengers ME,Schonewille WJ,Bot JC,Lycklama A Nijeholt GJ,Lin

doi

10.1136/neurintsurg-2018-014619

subject

Has Abstract

pub_date

2019-09-01 00:00:00

pages

866-873

issue

eissn

1759-8478

issn

1759-8486

pii

neurintsurg-2018-014619

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry.