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

被引：52

作者：

Jansen, Ivo G. H. ^{[1
,22
]}

Mulder, Maxim J. H. L. ^{[2
,29
]}

Goldhoorn, Robert-Jan B. ^{[3
,24
,25
,26
]}

Boers, Anna M. M. ^{[1
,4
,61
]}

van Es, Adriaan C. G. M. ^{[5
]}

Yo, Lonneke S. F. ^{[6
,53
]}

Hofmeijer, Jeannette ^{[7
,33
]}

Martens, Jasper M. ^{[8
,34
]}

van Walderveen, Marianne A. A. ^{[9
,31
]}

van der Kallen, Bas F. W. ^{[10
]}

Jenniskens, Sjoerd F. M. ^{[11
]}

Treurniet, Kilian M. ^{[1
]}

Marqueriny, Henk A. ^{[1
,4
]}

Sprengers, Marieke E. S. ^{[1
]}

Schonewille, Wouter J. ^{[12
,30
]}

Bot, Joost C. J. ^{[13
]}

Lycklama A Nijeholt, Geert J. ^{[14
,35
]}

Lingsma, Hester F. ^{[15
,57
]}

Liebeskind, David S. ^{[16
]}

Boiten, Jelis ^{[10
,27
]}

Vos, Jan-Albert ^{[17
,28
]}

Roos, Yvo B. W. E. M. ^{[18
,23
]}

van Oostenbrugge, Robert J. ^{[3
,24
,25
]}

van der Lugt, Aad ^{[5
,21
]}

van Zwam, Wim H. ^{[19
,25
,26
]}

Dippel, Diederik W. J. ^{[2
,20
]}

van den Wijngaard, Ido R. ^{[10
]}

Majoie, Charles B. L. M. ^{[1
,22
]}

Coutinho, Jonathan M. ^{[23
]}

Wermern, Marieke J. H. ^{[59
]}

Staals, Julie ^{[24
,25
]}

Roozenbeek, Bob ^{[20
]}

Emmer, Bart J. ^{[21
]}

de Bruijn, Sebastiaan F. ^{[36
]}

van Dijk, Lukas C. ^{[37
]}

van der Worp, H. Bart ^{[38
]}

Lo, Rob H. ^{[39
]}

van Dijk, Ewoud J. ^{[40
]}

Boogaarts, Hieronymus D. ^{[41
]}

de Kort, Paul L. M. ^{[42
]}

Peluso, Jo J. P. ^{[43
]}

van den Berg, Jan S. P. ^{[44
]}

van Hasselt, Boudewijn A. A. M. ^{[45
]}

Aerden, Leo A. M. ^{[46
]}

Dallinga, Rene J. ^{[47
]}

Uyttenboogaart, Maarten ^{[48
]}

Eshghi, Omid ^{[49
]}

Schreuder, Tobien H. C. M. L. ^{[50
]}

Heijboer, Roel J. J. ^{[51
]}

Keizer, Koos ^{[52
]}

机构：

[1] Amsterdam Univ Med Ctr AMC, Radiol & Nucl Med, Amsterdam, Netherlands

[2] Erasmus MC, Neurol, Rotterdam, Netherlands

[3] Maastricht Univ, Neurol, Med Ctr, Maastricht, Netherlands

[4] Amsterdam Univ Med Ctr AMC, Biomed Engn & Phys, Amsterdam, Netherlands

[5] Erasmus MC, Radiol, Rotterdam, Netherlands

[6] Catharina Hosp, Radiol, Eindhoven, Netherlands

[7] Rijnstate Hosp, Neurol, Arnhem, Netherlands

[8] Rijnstate Hosp, Radiol, Arnhem, Netherlands

[9] Leiden Univ, Radiol, Med Ctr, Leiden, Netherlands

[10] Haaglanden Med Ctr, Neurol, The Hague, Netherlands

[11] Radboud Univ Nijmegen, Radiol, Med Ctr, Nijmegen, Netherlands

[12] St Antonius Hosp, Neurol, Nieuwegein, Netherlands

[13] Amsterdam Univ Med Ctr VUMC, Radiol, Amsterdam, Netherlands

[14] Haaglanden Med Ctr, Radiol, The Hague, Netherlands

[15] Erasmus MC, Publ Hlth, Rotterdam, Netherlands

[16] UCLA, Neurol, Los Angeles, CA USA

[17] St Antonius Hosp, Radiol, Nieuwegein, Netherlands

[18] Amsterdam Univ Med Ctr AMC, Neurol, Amsterdam, Netherlands

[19] Maastricht Univ, Radiol, Med Ctr, Maastricht, Netherlands

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

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

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

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

[24] Maastricht Univ, Dept Neurol, Med Ctr, Maastricht, Netherlands

[25] Cardiovasc Res Inst Maastricht CARIM, Maastricht, Netherlands

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

[27] MC Haaglanden, Dept Neurol, The Hague, Netherlands

[28] St Antonius Hosp, Dept Radiol, Nieuwegein, Netherlands

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

[30] St Antonius Hosp, Dept Neurol, Nieuwegein, Netherlands

[31] Leiden Univ, Dept Radiol, Med Ctr, Leiden, Netherlands

[32] Texas Stroke Inst, Dept Radiol, Plano, TX USA

[33] Rijnstate Hosp, Dept Neurol, Arnhem, Netherlands

[34] Rijnstate Hosp, Dept Radiol, Arnhem, Netherlands

[35] MC Haaglanden, Dept Radiol, The Hague, Netherlands

[36] HAGA Hosp, Dept Neurol, The Hague, Netherlands

[37] HAGA Hosp, Dept Radiol, The Hague, Netherlands

[38] Univ Med Ctr Utrecht, Dept Neurol, Utrecht, Netherlands

[39] Univ Med Ctr Utrecht, Dept Radiol, Utrecht, Netherlands

[40] Radboud Univ Nijmegen, Dept Neurol, Med Ctr, Nijmegen, Netherlands

[41] Radboud Univ Nijmegen, Dept Neurosurg, Med Ctr, Nijmegen, Netherlands

[42] Sint Elisabeth Hosp, Dept Neurol, Tilburg, Netherlands

[43] Sint Elisabeth Hosp, Dept Radiol, Tilburg, Netherlands

[44] Isala Klin, Dept Neurol, Zwolle, Netherlands

[45] Isala Klin, Dept Radiol, Zwolle, Netherlands

[46] Reinier de Graaf Gasthuis, Dept Neurol, Delft, Netherlands

[47] Reinier de Graaf Gasthuis, Dept Radiol, Delft, Netherlands

[48] Univ Med Ctr Groningen, Dept Neurol, Groningen, Netherlands

[49] Univ Med Ctr Groningen, Dept Radiol, Groningen, Netherlands

[50] Atrium Med Ctr, Dept Neurol, Heerlen, Netherlands

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2019年 / 11卷 / 09期

关键词：

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

D O I：

10.1136/neurintsurg-2018-014619

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

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.

引用

页码：866 / 873

页数：9

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