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

MR CLEAN Registry Investigators, van Es, A. C. G. M., Yo, L. S. F., Hofmeijer, J., Martens, J. M., van Walderveen, M. A. A., van der Kallen, B. F. W., Jenniskens, S. F. M., Treurniet, K. M., Marqueriny, H. A., Sprengers, M. E. S., Bot, J., Lycklama A Nijeholt, G. J., Lingsma, H. F., Liebeskind, D. S., Boiten, J., Vos, J-A., Roos, Y. B. W. E. M., van Oostenbrugge, R. J., van der Lugt, A., van Zwam, W. H., Dippel, D. W. J., van den Wijngaard, I. R. & Majoie, C. B. L. M., Sep-2019, In : Journal of Neurointerventional Surgery. 11, 9, p. 866-873 9 p.

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  • Impact of single phase CT angiography collateral status on functional outcome over time

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DOI

  • MR CLEAN Registry Investigators
  • Adriaan C. G. M. van Es
  • Lonneke S. F. Yo
  • Jeannette Hofmeijer
  • Jasper M. Martens
  • Marianne A. A. van Walderveen
  • Bas F. W. van der Kallen
  • Sjoerd F. M. Jenniskens
  • Kilian M. Treurniet
  • Henk A. Marqueriny
  • Marieke E. S. Sprengers
  • Joost Bot
  • Geert J. Lycklama A Nijeholt
  • Hester F. Lingsma
  • David S. Liebeskind
  • Jelis Boiten
  • Jan-Albert Vos
  • Yvo B. W. E. M. Roos
  • Robert J. van Oostenbrugge
  • Aad van der Lugt
  • Wim H. van Zwam
  • Diederik W. J. Dippel
  • Ido R. van den Wijngaard
  • Charles B. L. M. Majoie

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

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.

Original languageEnglish
Pages (from-to)866-873
Number of pages9
JournalJournal of Neurointerventional Surgery
Volume11
Issue number9
Publication statusPublished - Sep-2019

    Keywords

  • COMPUTED TOMOGRAPHIC ANGIOGRAPHY, LEPTOMENINGEAL COLLATERALS, ENDOVASCULAR TREATMENT, STROKE, REPERFUSION, SCORE, MANAGEMENT, PREDICTOR, THERAPY

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