Collateral status and tissue outcome after intra-arterial therapy for patients with acute ischemic stroke

被引：53

作者：

Boers, Anna M. M. ^{[1
,2
,3
]}

Jansen, Ivo G. H. ^{[1
,3
]}

Berkhemer, Olvert A. ^{[1
,4
,5
]}

Yoo, Albert J. ^{[6
]}

Lingsma, Hester F. ^{[7
]}

Slump, Cornelis H. ^{[2
,8
]}

Roos, Yvo B. W. E. M. ^{[9
]}

van Oostenbrugge, Robert J. ^{[10
]}

Dippel, Diederik W. J. ^{[4
]}

van der Lugt, Aad ^{[11
]}

van Zwam, Wim H. ^{[5
,10
]}

Marquering, Henk A. ^{[1
,3
]}

Majoie, Charles B. L. M. ^{[1
]}

机构：

[1] Acad Med Ctr, Dept Radiol, Amsterdam, Netherlands

[2] Univ Twente, Dept Robot & Mechatron, Enschede, Netherlands

[3] Acad Med Ctr, Dept Biomed Engn & Phys, POB 22660, NL-1100 DD Amsterdam, Netherlands

[4] Erasmus MC Univ, Dept Neurol, Med Ctr, Rotterdam, Netherlands

[5] Maastricht Univ, Dept Radiol, Med Ctr, Maastricht, Netherlands

[6] Texas Stroke Inst, Div Neurointervent, Dallas, TX USA

[7] Erasmus MC Univ, Dept Publ Hlth, Med Ctr, Rotterdam, Netherlands

[8] Univ Twente, MIRA Inst Biomed Technol & Tech Med, Enschede, Netherlands

[9] Acad Med Ctr, Dept Neurol, Amsterdam, Netherlands

[10] Maastricht Univ, Cardiovasc Res Inst Maastricht CARIM, Dept Neurol, Med Ctr, Maastricht, Netherlands

[11] Erasmus MC Univ, Dept Radiol, Med Ctr, Rotterdam, Netherlands

来源：

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM | 2017年 / 37卷 / 11期

关键词：

Acute ischemic stroke; collateral circulation; final infarct volume; intra-arterial therapy; treatment effect; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; CT ANGIOGRAPHY; INTERVENTIONAL MANAGEMENT; ENDOVASCULAR TREATMENT; INFARCT VOLUME; III TRIAL; FLOW; DIFFUSION; OCCLUSION;

D O I：

10.1177/0271678X16678874

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Intra-arterial therapy (IAT) for ischemic stroke aims to save brain tissue. Collaterals are thought to contribute to prolonged penumbra sustenance. In this study, we investigate the effect of collateral status on brain tissue salvage with IAT. In 500 patients randomized between IAT and standard care, collateral status was graded from 0 (absent) to 3 (good). Final infarct volumes (FIV) were calculated on post-treatment CT. FIVs were compared between treatment groups per collateral grade. Multivariable linear regression with interaction terms was performed to study whether collaterals modified IAT effect on FIV. Four-hundred-forty-nine patients were included in the analysis. Median FIV for the IAT group was significantly lower with 54.5 mL (95% IQR: 21.8-145.0) than for the controls with 81.8 mL (95% IQR: 40.0-154.0) (p = 0.020). Treatment effect differed across collateral grades, although there was no significant interaction (unadjusted p = 0.054; adjusted p = 0.105). For grade 3, IAT resulted in a FIV reduction of 30.1 mL (p = 0.024). For grade 2 and 1, this difference was, respectively, 28.4 mL (p = 0.028) and 28.4 mL (p = 0.29). For grade 0, this was 88.6 mL (p = 0.28) in favour of controls. IAT saves substantially more brain tissue as compared to standard care. We observed a trend of increasing effect of IAT with higher collateral grades.

引用

页码：3589 / 3598

页数：10

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