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

Autor:	Boers AM; 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.; 2 Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands.; 3 Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands., Jansen IG; 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.; 3 Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands., Berkhemer OA; 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.; 4 Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.; 5 Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands., Yoo AJ; 6 Division of Neurointervention, Texas Stroke Institute, Dallas, TX, USA., Lingsma HF; 7 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands., Slump CH; 2 Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands.; 8 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands., Roos YB; 9 Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands., van Oostenbrugge RJ; 10 Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands., Dippel DW; 4 Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands., van der Lugt A; 11 Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands., van Zwam WH; 5 Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands.; 10 Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands., Marquering HA; 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.; 3 Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands., Majoie CB; 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism [J Cereb Blood Flow Metab] 2017 Nov; Vol. 37 (11), pp. 3589-3598. Date of Electronic Publication: 2016 Nov 19.
DOI:	10.1177/0271678X16678874
Abstrakt:	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.
Databáze:	MEDLINE
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