Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry.
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Jansen Ivo Gh, Mulder Maxim Jhl, Goldhoorn Robert-Jan B, Boers Anna Mm, van Es Adriaan Cgm, Yo Lonneke Sf, Hofmeijer Jeannette, Martens Jasper M, van Walderveen Marianne Aa, van der Kallen Bas Fw, Jenniskens Sjoerd Fm, Treurniet Kilian M, Marquering Henk A, Sprengers Marieke Es, Schonewille Wouter J, Bot Joost Cj, Lycklama A Nijeholt Geert J, Lingsma Hester F, Liebeskind David S, Boiten Jelis, Vos Jan Albert, Roos Yvo Bwem, van Oostenbrugge Robert J, van der Lugt Aad, van Zwam Wim H, Dippel Diederik Wj, van den Wijngaard Ido R, Majoie Charles Blm, MR CLEAN Registry investigators
Аннотация
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.