Abstract 6: Results From the DEFUSE 3 Trial: Good Leptomeningeal Collaterals Are Associated With Reduced Core Infarct Size but Not Improved Neurologic Outcome

Havenon, Adam de; Mlynash, Michael; Kim-Tenser, May; Lansberg, Maarten G; Leslie-Mazwi, T; Christensen, Søren; McTaggart, Ryan; Alexander, Matthew; Albers, Greg; Broderick, Joseph P.; Marks, Michael P.; Heit, Jeremy J

doi:10.1161/str.50.suppl_1.6

Cited by 17 publications

(24 citation statements)

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“…We found that poor baseline collateral status is associated with increased infarct growth between baseline and 24-h imaging. This finding is consistent with other studies that have examined the impact of collateral status on infarct growth in this time window (10). Secondly, we found that absence of reperfusion is associated with increased infarct growth beyond 24-h.…”

Section: Discussionsupporting

confidence: 93%

Predictors of Early and Late Infarct Growth in DEFUSE 3

et al. 2021

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Introduction: The goal of this study is to explore the impact of reperfusion and collateral status on infarct growth in the early and late time windows.Materials and Methods: Seventy patients from the DEFUSE 3 trial (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) with baseline, 24-h, and late follow-up scans were evaluated. Scans were taken with DWI or CTP at time of enrollment (Baseline), with DWI or CT 24-h after enrollment (24-h), and with DWI or CT 5 days after enrollment (Late). Early infarct growth (between baseline and 24-h scans) and late infarct growth (between 24-h and late scans) was assessed for each patient. The impact of collateral and reperfusion status on infarct growth was assessed in univariate and multivariate regression.Results: The median early infarct growth was 30.3 ml (IQR 16.4–74.5) and the median late infarct growth was 6.7 ml (IQR −3.5–21.6) in the overall sample. Patients with poor collaterals showed greater early infarct growth (Median 58.5 ml; IQR 18.6–125.6) compared to patients with good collaterals (Median 28.4 ml; IQR 15.8–49.3, unadjusted p = 0.04, adjusted p = 0.06) but showed no difference in late infarct growth. In contrast, patients who reperfused showed no reduction in early infarct growth but showed reduced late infarct growth (Median 1.9 ml; IQR −6.1–8.5) compared to patients without reperfusion (Median 11.2 ml; IQR −1.1–27.2, unadjusted p < 0.01, adjusted p = 0.04).Discussion: In the DEFUSE 3 population, poor collaterals predict early infarct growth and absence of reperfusion predicts late infarct growth. These results highlight the need for timely reperfusion therapy, particularly in patients with poor collaterals and indicate that the 24-h timepoint is too early to assess the full impact of reperfusion therapy on infarct growth.Clinical Trial Registration:http://www.clinicaltrials.gov, Unique identifier [NCT02586415].

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Section: Discussionsupporting

confidence: 93%

Predictors of Early and Late Infarct Growth in DEFUSE 3

et al. 2021

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“…Patients with a robust filling of arteries distal to the site of occlusion on CTA are deemed to have favorable collaterals . However, analyses based on CTA imaging do not provide information as to how much blood flows into the ischaemic tissue and this limitation may partially explain the heterogeneous response of patients with favorable CTA collaterals to EMT and the finding that the CTA collateral score did not predict outcomes in late‐window thrombectomy patients selected for treatment by CT or MR perfusion imaging . Our results suggest that HIR and perfusion‐based measures of collateral flow might be superior to angiographic measures of collaterals in early as well as late time windows and future studies should test this hypothesis.…”

Section: Discussionmentioning

confidence: 79%

Hypoperfusion intensity ratio correlates with angiographic collaterals in acute ischaemic stroke with M1 occlusion

Guenego

Fahed

Albers

et al. 2020

Euro J of Neurology

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Background and purpose: Among patients with an acute ischaemic stroke secondary to large-vessel occlusion, the hypoperfusion intensity ratio (HIR) [time to maximum (TMax) > 10 volume/TMax > 6 volume] is a strong predictor of infarct growth. We studied the correlation between HIR and collaterals assessed with digital subtraction angiography (DSA) before thrombectomy. Methods: Between January 2014 and March 2018, consecutive patients with an acute ischaemic stroke and an M1 middle cerebral artery (MCA) occlusion who underwent perfusion imaging and endovascular treatment at our center were screened. Ischaemic core (mL), HIR and perfusion mismatch (TMax > 6 s minus core volume) were assessed through magnetic resonance imaging or computed tomography perfusion. Collaterals were assessed on pre-intervention DSA using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Baseline clinical and perfusion characteristics were compared between patients with good (ASITN/SIR score 3-4) and those with poor (ASITN/SIR score 0-2) DSA collaterals. Correlation between HIR and ASITN/SIR scores was evaluated using Pearson's correlation. Receiver operating characteristic analysis was performed to determine the optimal HIR threshold for the prediction of good DSA collaterals. Results: A total of 98 patients were included; 49% (48/98) had good DSA collaterals and these patients had significantly smaller hypoperfusion volumes (TMax > 6 s, 89 vs. 125 mL; P = 0.007) and perfusion mismatch volumes (72 vs. 89 mL; P = 0.016). HIR was significantly correlated with DSA collaterals (À0.327; 95% confidence interval, À0.494 to À0.138; P = 0.01). An HIR cutoff of <0.4 best predicted good DSA collaterals with an odds ratio of 4.3 (95% confidence interval, 1.8-10.1) (sensitivity, 0.792; specificity, 0.560; area under curve, 0.708). Conclusion: The HIR is a robust indicator of angiographic collaterals and might be used as a surrogate of collateral assessment in patients undergoing magnetic resonance imaging. HIR <0.4 best predicted good DSA collaterals.

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“…Second, this study cannot provide information on clinical outcomes after EVT according to the three different selection methods. In the DEFUSE-3 trial, pretreatment infarct core volumes of <70 mL (too large for inclusion according to the DAWN trial criteria) are associated with benefits for EVT, and good leptomeningeal collaterals on single-phase CT angiography were not predictive of outcomes [12,13]. Future studies are warranted to clarify this issue.…”

Section: Discussionmentioning

confidence: 99%

Selection of Candidates for Endovascular Treatment: Characteristics According to Three Different Selection Methods

et al. 2019

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Background and Purpose To investigate the number and characteristics of patients eligible for endovascular treatment (EVT) determined using three different selection methods: clinical-core mismatch, target mismatch, and collateral status. Methods Using the data of consecutive patients from two prospectively maintained registries of university medical centers, the number and characteristics of patients according to the three selection methods were investigated and their correlation was analyzed. Patients with anterior circulation stroke due to occlusion of the middle cerebral and/or internal carotid artery and a National Institute of Health Stroke Scale (NIHSS) score of ≥6 points, who arrived within 8 hours or between 6 and 12 hours of symptom onset and underwent magnetic resonance imaging prior to EVT, were included. Collateral status was assessed using magnetic resonance perfusion-derived collateral flow maps. Results Three hundred thirty-five patients were investigated; the proportions of patients who were eligible and ineligible for EVT in all three selection methods were both small (n=85, 25.4%; n=54, 16.1%, respectively). The intercorrelation among the three selection methods was low (κ=0.235). The baseline NIHSS score and onset-to-selection time interval were associated with the presence of clinical-core mismatch, while the penumbra/core volume ratio and onset-to-selection time interval were related to target mismatch; none of these variables were associated with collateral status. The infarct core volume was associated with favorable profiles in all three selection methods. Conclusions Although the application of individual selection methods resulted in favorable outcomes after EVT in clinical trials, there is a significant discrepancy in EVT eligibility depending on the selection method used.

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Abstract 6: Results From the DEFUSE 3 Trial: Good Leptomeningeal Collaterals Are Associated With Reduced Core Infarct Size but Not Improved Neurologic Outcome

Cited by 17 publications

References 0 publications

Predictors of Early and Late Infarct Growth in DEFUSE 3

Predictors of Early and Late Infarct Growth in DEFUSE 3

Hypoperfusion intensity ratio correlates with angiographic collaterals in acute ischaemic stroke with M1 occlusion

Selection of Candidates for Endovascular Treatment: Characteristics According to Three Different Selection Methods

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