Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke
Recent randomized trials have proven the benefit of intra-arterial treatment (IAT) with retrievable stents in acute ischemic stroke. Patients with poor or absent collaterals (preexistent anastomoses to maintain blood flow in case of a primary vessel occlusion) may gain less clinical benefit from IAT...
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| Veröffentlicht in: | Stroke (1970) 2016-03, Vol.47 (3), p.768-776 |
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| container_title | Stroke (1970) |
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| creator | Berkhemer, Olvert A Jansen, Ivo G H Beumer, Debbie Fransen, Puck S S van den Berg, Lucie A Yoo, Albert J Lingsma, Hester F Sprengers, Marieke E S Jenniskens, Sjoerd F M Lycklama À Nijeholt, Geert J van Walderveen, Marianne A A van den Berg, René Bot, Joseph C J Beenen, Ludo F M Boers, Anna M M Slump, Cornelis H Roos, Yvo B W E M van Oostenbrugge, Robert J Dippel, Diederik W J van der Lugt, Aad van Zwam, Wim H Marquering, Henk A Majoie, Charles B L M |
| description | Recent randomized trials have proven the benefit of intra-arterial treatment (IAT) with retrievable stents in acute ischemic stroke. Patients with poor or absent collaterals (preexistent anastomoses to maintain blood flow in case of a primary vessel occlusion) may gain less clinical benefit from IAT. In this post hoc analysis, we aimed to assess whether the effect of IAT was modified by collateral status on baseline computed tomographic angiography in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN).
MR CLEAN was a multicenter, randomized trial of IAT versus no IAT. Primary outcome was the modified Rankin Scale at 90 days. The primary effect parameter was the adjusted common odds ratio for a shift in direction of a better outcome on the modified Rankin Scale. Collaterals were graded from 0 (absent) to 3 (good). We used multivariable ordinal logistic regression analysis with interaction terms to estimate treatment effect modification by collateral status.
We found a significant modification of treatment effect by collaterals (P=0.038). The strongest benefit (adjusted common odds ratio 3.2 [95% confidence intervals 1.7-6.2]) was found in patients with good collaterals (grade 3). The adjusted common odds ratio was 1.6 [95% confidence intervals 1.0-2.7] for moderate collaterals (grade 2), 1.2 [95% confidence intervals 0.7-2.3] for poor collaterals (grade 1), and 1.0 [95% confidence intervals 0.1-8.7] for patients with absent collaterals (grade 0).
In MR CLEAN, baseline computed tomographic angiography collateral status modified the treatment effect. The benefit of IAT was greatest in patients with good collaterals on baseline computed tomographic angiography. Treatment benefit appeared less and may be absent in patients with absent or poor collaterals.
URL: http://www.trialregister.nl and http://www.controlled-trials.com. Unique identifier: (NTR)1804 and ISRCTN10888758, respectively. |
| doi_str_mv | 10.1161/STROKEAHA.115.011788 |
| format | Article |
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MR CLEAN was a multicenter, randomized trial of IAT versus no IAT. Primary outcome was the modified Rankin Scale at 90 days. The primary effect parameter was the adjusted common odds ratio for a shift in direction of a better outcome on the modified Rankin Scale. Collaterals were graded from 0 (absent) to 3 (good). We used multivariable ordinal logistic regression analysis with interaction terms to estimate treatment effect modification by collateral status.
We found a significant modification of treatment effect by collaterals (P=0.038). The strongest benefit (adjusted common odds ratio 3.2 [95% confidence intervals 1.7-6.2]) was found in patients with good collaterals (grade 3). The adjusted common odds ratio was 1.6 [95% confidence intervals 1.0-2.7] for moderate collaterals (grade 2), 1.2 [95% confidence intervals 0.7-2.3] for poor collaterals (grade 1), and 1.0 [95% confidence intervals 0.1-8.7] for patients with absent collaterals (grade 0).
In MR CLEAN, baseline computed tomographic angiography collateral status modified the treatment effect. The benefit of IAT was greatest in patients with good collaterals on baseline computed tomographic angiography. Treatment benefit appeared less and may be absent in patients with absent or poor collaterals.
URL: http://www.trialregister.nl and http://www.controlled-trials.com. Unique identifier: (NTR)1804 and ISRCTN10888758, respectively.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.115.011788</identifier><identifier>PMID: 26903582</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Cerebral Angiography - methods ; Cerebrovascular Circulation - physiology ; Collateral Circulation - physiology ; Endovascular Procedures - methods ; Female ; Humans ; Infusions, Intra-Arterial - methods ; Male ; Middle Aged ; Stroke - diagnostic imaging ; Stroke - therapy ; Tomography, X-Ray Computed - methods</subject><ispartof>Stroke (1970), 2016-03, Vol.47 (3), p.768-776</ispartof><rights>2016 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c423t-12c290affee434c2b17f4644f1f36aec939518319ec49609c967726a2d12cab83</citedby><cites>FETCH-LOGICAL-c423t-12c290affee434c2b17f4644f1f36aec939518319ec49609c967726a2d12cab83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26903582$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Berkhemer, Olvert A</creatorcontrib><creatorcontrib>Jansen, Ivo G H</creatorcontrib><creatorcontrib>Beumer, Debbie</creatorcontrib><creatorcontrib>Fransen, Puck S S</creatorcontrib><creatorcontrib>van den Berg, Lucie A</creatorcontrib><creatorcontrib>Yoo, Albert J</creatorcontrib><creatorcontrib>Lingsma, Hester F</creatorcontrib><creatorcontrib>Sprengers, Marieke E S</creatorcontrib><creatorcontrib>Jenniskens, Sjoerd F M</creatorcontrib><creatorcontrib>Lycklama À Nijeholt, Geert J</creatorcontrib><creatorcontrib>van Walderveen, Marianne A A</creatorcontrib><creatorcontrib>van den Berg, René</creatorcontrib><creatorcontrib>Bot, Joseph C J</creatorcontrib><creatorcontrib>Beenen, Ludo F M</creatorcontrib><creatorcontrib>Boers, Anna M M</creatorcontrib><creatorcontrib>Slump, Cornelis H</creatorcontrib><creatorcontrib>Roos, Yvo B W E M</creatorcontrib><creatorcontrib>van Oostenbrugge, Robert J</creatorcontrib><creatorcontrib>Dippel, Diederik W J</creatorcontrib><creatorcontrib>van der Lugt, Aad</creatorcontrib><creatorcontrib>van Zwam, Wim H</creatorcontrib><creatorcontrib>Marquering, Henk A</creatorcontrib><creatorcontrib>Majoie, Charles B L M</creatorcontrib><creatorcontrib>MR CLEAN Investigators</creatorcontrib><title>Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Recent randomized trials have proven the benefit of intra-arterial treatment (IAT) with retrievable stents in acute ischemic stroke. Patients with poor or absent collaterals (preexistent anastomoses to maintain blood flow in case of a primary vessel occlusion) may gain less clinical benefit from IAT. In this post hoc analysis, we aimed to assess whether the effect of IAT was modified by collateral status on baseline computed tomographic angiography in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN).
MR CLEAN was a multicenter, randomized trial of IAT versus no IAT. Primary outcome was the modified Rankin Scale at 90 days. The primary effect parameter was the adjusted common odds ratio for a shift in direction of a better outcome on the modified Rankin Scale. Collaterals were graded from 0 (absent) to 3 (good). We used multivariable ordinal logistic regression analysis with interaction terms to estimate treatment effect modification by collateral status.
We found a significant modification of treatment effect by collaterals (P=0.038). The strongest benefit (adjusted common odds ratio 3.2 [95% confidence intervals 1.7-6.2]) was found in patients with good collaterals (grade 3). The adjusted common odds ratio was 1.6 [95% confidence intervals 1.0-2.7] for moderate collaterals (grade 2), 1.2 [95% confidence intervals 0.7-2.3] for poor collaterals (grade 1), and 1.0 [95% confidence intervals 0.1-8.7] for patients with absent collaterals (grade 0).
In MR CLEAN, baseline computed tomographic angiography collateral status modified the treatment effect. The benefit of IAT was greatest in patients with good collaterals on baseline computed tomographic angiography. Treatment benefit appeared less and may be absent in patients with absent or poor collaterals.
URL: http://www.trialregister.nl and http://www.controlled-trials.com. Unique identifier: (NTR)1804 and ISRCTN10888758, respectively.</description><subject>Aged</subject><subject>Cerebral Angiography - methods</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>Collateral Circulation - physiology</subject><subject>Endovascular Procedures - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Infusions, Intra-Arterial - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Stroke - diagnostic imaging</subject><subject>Stroke - therapy</subject><subject>Tomography, X-Ray Computed - methods</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9UV1P2zAUtaah0QH_ACE_7iXgrzjxYxaVFQ0JRIt4jFz3pnhL7M52pPFP9nPnqoWnq3N1Pq59ELqk5JpSSW-Wq6eHn_Nm0WRYXhNKq7r-hGa0ZKIQktWf0YwQrgomlDpFX2P8RQhhvC6_oFMmFeFlzWboX-uHQScIesDLpNMUsXf4u44wWAe49eNuSrDBKz_6bdC7V2tw47b2AN6wdht851LQRROyi802qwA6jeASnvc9mIStw4862byJ-MWmV_wY_F87Zmrj9hofcGuDmfIdNocvU_C_4Ryd9HqIcHGcZ-j5dr5qF8X9w4-7trkvjGA8FZQZpojOQSC4MGxNq15IIXrac6nBKK5KWnOqwAgliTJKVhWTmm2yUq9rfoa-HXx3wf-ZIKZutNFA_hQHfoodrWSlaCkrnqniQDXBxxig73YhPyO8dZR0-066j04yLLtDJ1l2dUyY1iNsPkTvJfD_kNuLKg</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Berkhemer, Olvert A</creator><creator>Jansen, Ivo G H</creator><creator>Beumer, Debbie</creator><creator>Fransen, Puck S S</creator><creator>van den Berg, Lucie A</creator><creator>Yoo, Albert J</creator><creator>Lingsma, Hester F</creator><creator>Sprengers, Marieke E S</creator><creator>Jenniskens, Sjoerd F M</creator><creator>Lycklama À Nijeholt, Geert J</creator><creator>van Walderveen, Marianne A A</creator><creator>van den Berg, René</creator><creator>Bot, Joseph C J</creator><creator>Beenen, Ludo F M</creator><creator>Boers, Anna M M</creator><creator>Slump, Cornelis H</creator><creator>Roos, Yvo B W E M</creator><creator>van Oostenbrugge, Robert J</creator><creator>Dippel, Diederik W J</creator><creator>van der Lugt, Aad</creator><creator>van Zwam, Wim H</creator><creator>Marquering, Henk A</creator><creator>Majoie, Charles B L M</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160301</creationdate><title>Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke</title><author>Berkhemer, Olvert A ; Jansen, Ivo G H ; Beumer, Debbie ; Fransen, Puck S S ; van den Berg, Lucie A ; Yoo, Albert J ; Lingsma, Hester F ; Sprengers, Marieke E S ; Jenniskens, Sjoerd F M ; Lycklama À Nijeholt, Geert J ; van Walderveen, Marianne A A ; van den Berg, René ; Bot, Joseph C J ; Beenen, Ludo F M ; Boers, Anna M M ; Slump, Cornelis H ; Roos, Yvo B W E M ; van Oostenbrugge, Robert J ; Dippel, Diederik W J ; van der Lugt, Aad ; van Zwam, Wim H ; Marquering, Henk A ; Majoie, Charles B L M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c423t-12c290affee434c2b17f4644f1f36aec939518319ec49609c967726a2d12cab83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Cerebral Angiography - methods</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>Collateral Circulation - physiology</topic><topic>Endovascular Procedures - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Infusions, Intra-Arterial - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Stroke - diagnostic imaging</topic><topic>Stroke - therapy</topic><topic>Tomography, X-Ray Computed - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Berkhemer, Olvert A</creatorcontrib><creatorcontrib>Jansen, Ivo G H</creatorcontrib><creatorcontrib>Beumer, Debbie</creatorcontrib><creatorcontrib>Fransen, Puck S S</creatorcontrib><creatorcontrib>van den Berg, Lucie A</creatorcontrib><creatorcontrib>Yoo, Albert J</creatorcontrib><creatorcontrib>Lingsma, Hester F</creatorcontrib><creatorcontrib>Sprengers, Marieke E S</creatorcontrib><creatorcontrib>Jenniskens, Sjoerd F M</creatorcontrib><creatorcontrib>Lycklama À Nijeholt, Geert J</creatorcontrib><creatorcontrib>van Walderveen, Marianne A A</creatorcontrib><creatorcontrib>van den Berg, René</creatorcontrib><creatorcontrib>Bot, Joseph C J</creatorcontrib><creatorcontrib>Beenen, Ludo F M</creatorcontrib><creatorcontrib>Boers, Anna M M</creatorcontrib><creatorcontrib>Slump, Cornelis H</creatorcontrib><creatorcontrib>Roos, Yvo B W E M</creatorcontrib><creatorcontrib>van Oostenbrugge, Robert J</creatorcontrib><creatorcontrib>Dippel, Diederik W J</creatorcontrib><creatorcontrib>van der Lugt, Aad</creatorcontrib><creatorcontrib>van Zwam, Wim H</creatorcontrib><creatorcontrib>Marquering, Henk A</creatorcontrib><creatorcontrib>Majoie, Charles B L M</creatorcontrib><creatorcontrib>MR CLEAN Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Berkhemer, Olvert A</au><au>Jansen, Ivo G H</au><au>Beumer, Debbie</au><au>Fransen, Puck S S</au><au>van den Berg, Lucie A</au><au>Yoo, Albert J</au><au>Lingsma, Hester F</au><au>Sprengers, Marieke E S</au><au>Jenniskens, Sjoerd F M</au><au>Lycklama À Nijeholt, Geert J</au><au>van Walderveen, Marianne A A</au><au>van den Berg, René</au><au>Bot, Joseph C J</au><au>Beenen, Ludo F M</au><au>Boers, Anna M M</au><au>Slump, Cornelis H</au><au>Roos, Yvo B W E M</au><au>van Oostenbrugge, Robert J</au><au>Dippel, Diederik W J</au><au>van der Lugt, Aad</au><au>van Zwam, Wim H</au><au>Marquering, Henk A</au><au>Majoie, Charles B L M</au><aucorp>MR CLEAN Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>47</volume><issue>3</issue><spage>768</spage><epage>776</epage><pages>768-776</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><abstract>Recent randomized trials have proven the benefit of intra-arterial treatment (IAT) with retrievable stents in acute ischemic stroke. Patients with poor or absent collaterals (preexistent anastomoses to maintain blood flow in case of a primary vessel occlusion) may gain less clinical benefit from IAT. In this post hoc analysis, we aimed to assess whether the effect of IAT was modified by collateral status on baseline computed tomographic angiography in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN).
MR CLEAN was a multicenter, randomized trial of IAT versus no IAT. Primary outcome was the modified Rankin Scale at 90 days. The primary effect parameter was the adjusted common odds ratio for a shift in direction of a better outcome on the modified Rankin Scale. Collaterals were graded from 0 (absent) to 3 (good). We used multivariable ordinal logistic regression analysis with interaction terms to estimate treatment effect modification by collateral status.
We found a significant modification of treatment effect by collaterals (P=0.038). The strongest benefit (adjusted common odds ratio 3.2 [95% confidence intervals 1.7-6.2]) was found in patients with good collaterals (grade 3). The adjusted common odds ratio was 1.6 [95% confidence intervals 1.0-2.7] for moderate collaterals (grade 2), 1.2 [95% confidence intervals 0.7-2.3] for poor collaterals (grade 1), and 1.0 [95% confidence intervals 0.1-8.7] for patients with absent collaterals (grade 0).
In MR CLEAN, baseline computed tomographic angiography collateral status modified the treatment effect. The benefit of IAT was greatest in patients with good collaterals on baseline computed tomographic angiography. Treatment benefit appeared less and may be absent in patients with absent or poor collaterals.
URL: http://www.trialregister.nl and http://www.controlled-trials.com. Unique identifier: (NTR)1804 and ISRCTN10888758, respectively.</abstract><cop>United States</cop><pmid>26903582</pmid><doi>10.1161/STROKEAHA.115.011788</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0039-2499 |
| ispartof | Stroke (1970), 2016-03, Vol.47 (3), p.768-776 |
| issn | 0039-2499 1524-4628 |
| language | eng |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Aged Cerebral Angiography - methods Cerebrovascular Circulation - physiology Collateral Circulation - physiology Endovascular Procedures - methods Female Humans Infusions, Intra-Arterial - methods Male Middle Aged Stroke - diagnostic imaging Stroke - therapy Tomography, X-Ray Computed - methods |
| title | Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke |
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