Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry
- PMID: 30777890
- DOI: 10.1136/neurintsurg-2018-014619
Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry
Abstract
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.
Keywords: ct angiography; intervention; stroke.
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Conflict of interest statement
Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf. IGHJ owns stock in Nico lab BV, a company that focuses on the use of artificial intelligence for medical image analysis (https://www.nico-lab.com/). CBLMM reports grants from the TWIN Foundation, during the conduct of the study; grants from CVON/Dutch Heart Foundation, grants from Stryker, outside the submitted work (paid to institution); and owns stock in Nico lab BV. YBWEMR owns stock in Nico lab BV. WHZ reports personal fees from Codman and personal fees from Stryker, outside the submitted work. AL reports consulting fees from Stryker, outside the submitted work. DWJD reports grants from the Dutch Heart Foundation, AngioCare BV, Medtronic/Covidien/EV3, MEDAC Gmbh/LAMEPRO, Penumbra Inc, Top Medical/Concentric, and Stryker, during conduct of the study; and consultation fees from Stryker, Bracco Imaging, and Servier, received by the Erasmus University Medical Center, outside the submitted work. DL reports consultation fees from Stryker and Medtronic, outside the submitted work. AMMB and HAM report owning stock in Nico lab BV. All other authors did not receive support from any organization for the submitted work, had no financial relationships with any organizations that might have an interest in the submitted work in the previous three years and had no other relationships or activities that could appear to have influenced the submitted work.
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