Impact of single phase CT angiography collateral status on functional outcome over time : results from the MR CLEAN Registry
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
Journal of neurointerventional surgery - 11(2019), 9 vom: 03. Sept., Seite 866-873 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Jansen, Ivo Gh [VerfasserIn] |
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| Links: |
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| Themen: |
Ct angiography |
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| Anmerkungen: |
Date Completed 26.11.2019 Date Revised 26.11.2019 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1136/neurintsurg-2018-014619 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM294032371 |
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| 100 | 1 | |a Jansen, Ivo Gh |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impact of single phase CT angiography collateral status on functional outcome over time |b results from the MR CLEAN Registry |
| 264 | 1 | |c 2019 | |
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| 500 | |a Date Completed 26.11.2019 | ||
| 500 | |a Date Revised 26.11.2019 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a ct angiography | |
| 650 | 4 | |a intervention | |
| 650 | 4 | |a stroke | |
| 700 | 1 | |a Mulder, Maxim Jhl |e verfasserin |4 aut | |
| 700 | 1 | |a Goldhoorn, Robert-Jan B |e verfasserin |4 aut | |
| 700 | 1 | |a Boers, Anna Mm |e verfasserin |4 aut | |
| 700 | 1 | |a van Es, Adriaan Cgm |e verfasserin |4 aut | |
| 700 | 1 | |a Yo, Lonneke Sf |e verfasserin |4 aut | |
| 700 | 1 | |a Hofmeijer, Jeannette |e verfasserin |4 aut | |
| 700 | 1 | |a Martens, Jasper M |e verfasserin |4 aut | |
| 700 | 1 | |a van Walderveen, Marianne Aa |e verfasserin |4 aut | |
| 700 | 1 | |a van der Kallen, Bas Fw |e verfasserin |4 aut | |
| 700 | 1 | |a Jenniskens, Sjoerd Fm |e verfasserin |4 aut | |
| 700 | 1 | |a Treurniet, Kilian M |e verfasserin |4 aut | |
| 700 | 1 | |a Marquering, Henk A |e verfasserin |4 aut | |
| 700 | 1 | |a Sprengers, Marieke Es |e verfasserin |4 aut | |
| 700 | 1 | |a Schonewille, Wouter J |e verfasserin |4 aut | |
| 700 | 1 | |a Bot, Joost Cj |e verfasserin |4 aut | |
| 700 | 1 | |a Lycklama A Nijeholt, Geert J |e verfasserin |4 aut | |
| 700 | 1 | |a Lingsma, Hester F |e verfasserin |4 aut | |
| 700 | 1 | |a Liebeskind, David S |e verfasserin |4 aut | |
| 700 | 1 | |a Boiten, Jelis |e verfasserin |4 aut | |
| 700 | 1 | |a Vos, Jan Albert |e verfasserin |4 aut | |
| 700 | 1 | |a Roos, Yvo Bwem |e verfasserin |4 aut | |
| 700 | 1 | |a van Oostenbrugge, Robert J |e verfasserin |4 aut | |
| 700 | 1 | |a van der Lugt, Aad |e verfasserin |4 aut | |
| 700 | 1 | |a van Zwam, Wim H |e verfasserin |4 aut | |
| 700 | 1 | |a Dippel, Diederik Wj |e verfasserin |4 aut | |
| 700 | 1 | |a van den Wijngaard, Ido R |e verfasserin |4 aut | |
| 700 | 1 | |a Majoie, Charles Blm |e verfasserin |4 aut | |
| 700 | 0 | |a MR CLEAN Registry investigators |e verfasserin |4 aut | |
| 700 | 1 | |a J Dippel, Diederik W |e investigator |4 oth | |
| 700 | 1 | |a Der Lugt, Aad Van |e investigator |4 oth | |
| 700 | 1 | |a L M Majoie, Charles B |e investigator |4 oth | |
| 700 | 1 | |a W E M Roos, Yvo B |e investigator |4 oth | |
| 700 | 1 | |a Van Oostenbrugge, Robert J |e investigator |4 oth | |
| 700 | 1 | |a Van Zwam, Wim H |e investigator |4 oth | |
| 700 | 1 | |a Boiten, Jelis |e investigator |4 oth | |
| 700 | 1 | |a Vos, Jan Albert |e investigator |4 oth | |
| 700 | 1 | |a H Jansen, Ivo G |e investigator |4 oth | |
| 700 | 1 | |a H L Mulder, Maxim J |e investigator |4 oth | |
| 700 | 1 | |a Goldhoorn, Robert-Jan B |e investigator |4 oth | |
| 700 | 1 | |a Schonewille, Wouter J |e investigator |4 oth | |
| 700 | 1 | |a Coutinho, Jonathan M |e investigator |4 oth | |
| 700 | 1 | |a H Wermer, Marieke J |e investigator |4 oth | |
| 700 | 1 | |a A van Walderveen, Marianne A |e investigator |4 oth | |
| 700 | 1 | |a Staals, Julie |e investigator |4 oth | |
| 700 | 1 | |a Hofmeijer, Jeannette |e investigator |4 oth | |
| 700 | 1 | |a Martens, Jasper M |e investigator |4 oth | |
| 700 | 1 | |a Lycklama À Nijeholt, Geert J |e investigator |4 oth | |
| 700 | 1 | |a Roozenbeek, Bob |e investigator |4 oth | |
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| 700 | 1 | |a Van der Worp, H Bart |e investigator |4 oth | |
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| 700 | 1 | |a Boogaarts, Hieronymus D |e investigator |4 oth | |
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