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

ABSTRACT: 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.

SUBMITTER: Boers AM

PROVIDER: S-EPMC5669341 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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

Boers Anna Mm AM Jansen Ivo Gh IG Berkhemer Olvert A OA Yoo Albert J AJ Lingsma Hester F HF Slump Cornelis H CH Roos Yvo Bwem YB van Oostenbrugge Robert J RJ Dippel Diederik Wj DW van der Lugt Aad A van Zwam Wim H WH Marquering Henk A HA Majoie Charles Blm CB

Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism 20161119 11

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. Multivar ...[more]

PMID: 27864462

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Project description:BackgroundMixed data exist regarding the association between hyperglycemia and functional outcome after acute ischemic stroke when accounting for the impact of leptomeningeal collateral flow. We sought to determine whether collateral status modifies the association between treatment group and functional outcome in a subset of patients with large vessel occlusion enrolled in the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial.MethodsIn this post-hoc analysis, we analyzed patients enrolled into the SHINE trial with anterior circulation large vessel occlusion who underwent imaging with CT angiography prior to glucose control treatment group assignment. The primary analysis assessed the degree to which collateral status modified the effect between treatment group and functional outcome as defined by the 90-day modified Rankin Scale score. Logistic regression was used to model the data, with adjustments made for thrombectomy status, age, post-perfusion thrombolysis in cerebral infarction (TICI) score, tissue plasminogen activator (tPA) use, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Five SHINE trial centers contributed data for this analysis. Statistical significance was defined as a p-value < 0.05.ResultsAmong the 1151 patients in the SHINE trial, 57 with angiographic data were included in this sub-analysis, of whom 19 had poor collaterals and 38 had good collaterals. While collateral status had no effect (p = 0.855) on the association between glucose control treatment group and functional outcome, patients with good collaterals were more likely to have a favorable functional outcome (p = 0.001, OR 5.02; 95% CI 1.37-16.0).ConclusionsIn a post-hoc analysis using a subset of patients with angiographic data enrolled in the SHINE trial, collateral status did not modify the association between glucose control treatment group and functional outcome. However, consistent with prior studies, there was a significant association between good collateral status and favorable outcome in patients with large vessel occlusion stroke.Trial registrationClinicalTrials.gov Identifier is NCT01369069. Registration date is June 8, 2011.

Dataset Information

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

Publications

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

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