Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke

Berkhemer, Olvert A.; Jansen, Ivo G. H.; Beumer, Debbie; Fransen, Puck S.S.; Berg, Lucie A. van den; Yoo, Albert J.; Lingsma, Hester F.; Sprengers, Marieke E.S.; Jenniskens, Sjoerd F.M.; Nijeholt, Geert J. Lycklama à; Walderveen, Marianne A.A. van; Berg, René van den; Bot, Joseph C.J.; Beenen, Ludo F. M.; Boers, Anna M. M.; Slump, Cornelis H.; Roos, Yvo B.W.E.M.; Oostenbrugge, Robert J. van; Dippel, Diederik W.J.; Lugt, Aad van der; Zwam, Wim H. van; Marquering, Henk A.; Majoie, Charles B. L. M.; Schonewille, Wouter J.; Vos, Jan‐Albert; Nederkoorn, Paul J.; Wermer, Marieke J.H.; Staals, Julie; Hofmeijer, Jeannette; Oostayen, Jacques A. van; Boiten, Jelis; Brouwer, Patrick A.; Emmer, Bart J.; Bruijn, Sebastiaan F. de; Dijk, Lukas C. van; Kappelle, L. Jaap; Lo, Rob H.; Dijk, Ewoud J. van; Vries, Joost de; Kort, Paul L.M. de; Berg, Jan S.P. van den; Hassel, Boudewijn A.A.M. van; Aerden, Leo A.M.; Dallinga, René J.; Visser, Marieke C.; Vroomen, Patrick; Eshghi, Omid; Schreuder, Tobien H.C.M.L.; Heijboer, Roel J.J.; Keizer, Koos; Tielbeek, Alexander V.; Hertog, Heleen M. den; Gerrits, Dick; Berg-Vos, Renske M. van den; Karas, Giorgos B.; Koudstaal, Peter J.; Flach, H. Zwenneke; Steyerberg, Ewout W.; Brown, Martin M.; Liebig, Thomas; Stijnen, Theo

doi:10.1161/strokeaha.115.011788

Cited by 248 publications

(209 citation statements)

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“…They showed that patients with poor collaterals were four times more likely to clinically deteriorate in hospital as those with normal or exuberant collaterals. Other groups have also shown a relationship between collateral status and functional outcome20–22 with the recent post hoc analysis of the MR CLEAN data showing a significant modification of treatment effect by collateral status with the strongest benefit seen in patients with good collaterals (grade 3) and no effect seen in patients with absent collaterals (grade 0) 23. Our findings are consistent with previous reports with ∼70% of patients having good leptomeningeal collaterals.…”

Section: Discussionsupporting

confidence: 91%

Mechanical thrombectomy in patients with M1 occlusion and NIHSS score ≤5: a single-centre experience

et al. 2016

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BackgroundThe recent success of several mechanical thrombectomy trials has resulted in a significant change in management for patients presenting with stroke. However, it is still unclear how to manage patients that present with stroke and low National Institutes of Health Stroke Scale (NIHSS) ≤5. We sought to review our experience of mechanical thrombectomy in patients with low NIHSS and confirmed M1 occlusion.MethodsWe retrospectively analysed our prospectively maintained database of all patients undergoing mechanical thrombectomy between January 2008 and August 2016. We identified 41 patients with confirmed M1 occlusion and low NIHSS (≤5) on admission to our hospital. We collected demographic, radiological, procedural and outcome data.ResultsThe mean age of patients was 72±14, with 20 male patients. Associated medical conditions were common with hypertension seen in ∼80%. Just over 50% presented with NIHSS 4 or 5. The average ASPECTS score on admission was 8.8 (range 6–10), and the average clot length 10 mm. Angiographically Thrombolysis in Cerebral Infarction (TICI) ≥2b was obtained in 87.8% of patients. 7 patients had haemorrhage on follow-up, 2 of which were symptomatic. Of 40 patients with 90-day follow-up, 75% had modified Rankin Scale (mRS) score 0–2. There were 3 deaths at 90 days.ConclusionsMechanical thrombectomy in patients with low NIHSS and proximal large vessel occlusion is technically possible and carries a high degree of success with good safety profile. Patients with low NIHSS and confirmed occlusion should be considered for mechanical thrombectomy.

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Section: Discussionsupporting

confidence: 91%

Mechanical thrombectomy in patients with M1 occlusion and NIHSS score ≤5: a single-centre experience

et al. 2016

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“…However, our recanalization rates and outcomes are similar to the report of Sheth et al [6] that shows a successful recanalization in 87% of females versus 83% of males and functional independence at 3 months in 53% of females versus 56% of males. Besides, in our analysis, we included neither the collateral status nor the infarct volume, which are known outcome predictors [16,17]. Our study may be underpowered to detect sex differences (145 vs. 233 patients in the MR CLEAN trial [7]), but this is probably not the case, since the abovementioned cohort of 400 patients showed results overlapping with ours [6].…”

Section: Discussionmentioning

confidence: 99%

Is the Efficacy of Endovascular Treatment for Acute Ischemic Stroke Sex-Related

Carvalho¹,

Cunha²,

Gregório³

et al. 2017

Intervent Neurol

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Background: Several reports refer to differences in stroke between females and males, namely in incidence and clinical outcome, but also in response to treatments. Driven by a recent analysis of the MR CLEAN trial, which showed a higher benefit from acute stroke endovascular treatment (EVT) in males, we intended to determine if clinical outcomes after EVT differ between sexes, in a real-world setting. Methods: We analyzed 145 consecutive patients submitted to EVT for anterior circulation large-vessel occlusion, between January 2015 and September 2016, and compared the outcomes between sexes. Results: Our population was represented by 81 (55.9%) females, with similar baseline characteristics (pre-stroke disability, baseline NIHSS, and ASPECTS), rate of previous intravenous thrombolysis, time from onset to recanalization, and rate of revascularization; with the exception that women were on average 4 years older and had more hypertension, and men in turn had more tandem occlusions and atherosclerotic etiology (all p < 0.05). Even after adjusting for these statistically significant variables and for intravenous thrombolysis (as some studies advocate a different response to this treatment between sexes), there were no differences in intracranial hemorrhage, functional independence (mRS ≤2 in 60.9% males vs. 66.7% in females, p = 0.48; adjusted p = 0.36), or mortality at 3 months. Conclusion: In a real-world setting, we found no sex differences in clinical and safety outcomes after acute stroke EVT. Our results support the idea that women are equally likely to achieve good outcomes as men after acute stroke EVT.

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“…10, 11 We also tested for a confounding effect of time from onset to start intra-arterial treatment and general anesthesia because these parameters are known to affect outcome. 12,13 Finally, we tested for confounding by center.…”

Section: Discussionmentioning

confidence: 99%

Influence of Device Choice on the Effect of Intra-Arterial Treatment for Acute Ischemic Stroke in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands)

Dippel¹,

Majoie²,

Roos³

et al. 2016

Stroke

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Background and Purpose— Intra-arterial treatment by means of retrievable stents has been proven safe and effective. In MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), the choice of the type of thrombectomy device was left to the discretion of the interventionist. The aim of this study was to explore the differences in functional outcome, neurological recovery, reperfusion, extent of infarction, and adverse events according to stent type and make. Methods— The primary outcome was functional outcome at 90 days, assessed with the modified Rankin Scale (mRS). Neuroimaging outcomes included occlusion on computed tomographic angiography at 24 hours, infarct volume at 5 to 7 days, and modified thrombolysis in cerebral infarction scores. Safety outcomes included death within 90 days and any symptomatic intracerebral hemorrhage. We analyzed possible interactions between stent type and treatment with multiple regression models. Treatment effects were adjusted for patient age, stroke severity, and collateral score. Results— Of the 500 patients included in the trial, 233 were allocated to intervention. Of these, 124 (53%) were first treated with Trevo (adjusted common odds ratio for shift on the mRS [acOR, 1.98; 95% confidence interval, 1.30–2.92]), 31 (13%) with Solitaire (acOR, 1.90; 95% confidence interval, 0.97–3.73), 40 (17%) with other retrievable stents or mechanical devices (acOR, 0.96; 95% confidence interval, 0.51–3.93], and 38 (16%) could not be treated. There was no interaction between device and treatment effect on functional outcome and all other secondary and safety outcomes. Conclusions— We found no evidence for a differential effect of thrombectomy for acute ischemic stroke by type of stent. Clinical Trial Registration— URL: http://www.isrctn.com . Unique identifier: ISRCTN10888758.

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Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke

Cited by 248 publications

References 30 publications

Mechanical thrombectomy in patients with M1 occlusion and NIHSS score ≤5: a single-centre experience

Mechanical thrombectomy in patients with M1 occlusion and NIHSS score ≤5: a single-centre experience

Is the Efficacy of Endovascular Treatment for Acute Ischemic Stroke Sex-Related

Influence of Device Choice on the Effect of Intra-Arterial Treatment for Acute Ischemic Stroke in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands)

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