Simone M Uniken Venema1, Lennard Wolff2, Sophie A van den Berg2, Hendrik Reinink2, Sven P R Luijten2, Hester F Lingsma2, Henk A Marquering2, Anna M M Boers2, Joost Bot2, Sebastiaan Hammer2, Paul J Nederkoorn2, Yvo B W E M Roos2, Charles B L M Majoie2, Jan Willem Dankbaar2, Aad van der Lugt2, H Bart van der Worp2. 1. From the Departments of Neurology and Neurosurgery (S.M.U.V., H.R., H.B.v.d.W.), Brain Center, and Department of Radiology (J.W.D.), University Medical Center Utrecht; Departments of Radiology & Nuclear Medicine (L.W., S.P.R.L., A.v.d.L.), Public Health (H.F.L.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (S.A.v.d.B., P.J.N., Y.B.W.E.M.R.), Radiology and Nuclear Medicine (H.A.M., A.B.), Radiology and Nuclear Medicine (J.B., C.B.L.M.M.), and Biomedical Engineering & Physics (H.A.M., A.M.M.B.), Amsterdam University Medical Centers, University of Amsterdam; and Department of Radiology (S.H.), Haga Ziekenhuis, The Hague, the Netherlands s.m.unikenvenema@umcutrecht.nl. 2. From the Departments of Neurology and Neurosurgery (S.M.U.V., H.R., H.B.v.d.W.), Brain Center, and Department of Radiology (J.W.D.), University Medical Center Utrecht; Departments of Radiology & Nuclear Medicine (L.W., S.P.R.L., A.v.d.L.), Public Health (H.F.L.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (S.A.v.d.B., P.J.N., Y.B.W.E.M.R.), Radiology and Nuclear Medicine (H.A.M., A.B.), Radiology and Nuclear Medicine (J.B., C.B.L.M.M.), and Biomedical Engineering & Physics (H.A.M., A.M.M.B.), Amsterdam University Medical Centers, University of Amsterdam; and Department of Radiology (S.H.), Haga Ziekenhuis, The Hague, the Netherlands.
Abstract
BACKGROUND AND OBJECTIVES: In patients with ischemic stroke undergoing endovascular treatment (EVT), time to treatment and collateral status are important prognostic factors and may be correlated. We aimed to assess the relation between time to CT angiography (CTA) and a quantitatively determined collateral score and to assess whether the collateral score modified the relation between time to recanalization and functional outcome. METHODS: We analyzed data from patients with acute ischemic stroke included in the Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke Registry between 2014 and 2017, who had a carotid terminus or M1 occlusion and were treated with EVT within 6.5 hours of symptom onset. A quantitative collateral score (qCS) was determined from baseline CTA using a validated automated image analysis algorithm. We also determined a 4-point visual collateral score (vCS). Multivariable regression models were used to assess the relations between time to imaging and the qCS and between the time to recanalization and functional outcome (90-day modified Rankin Scale score). An interaction term (time to recanalization × qCS) was entered in the latter model to test whether the qCS modifies this relation. Sensitivity analyses were performed using the vCS. RESULTS: We analyzed 1,813 patients. The median time from symptom onset to CTA was 91 minutes (interquartile range [IQR] 65-150 minutes), and the median qCS was 49% (IQR 25%-78%). Longer time to CTA was not associated with the log-transformed qCS (adjusted β per 30 minutes, 0.002, 95% CI -0.006 to 0.011). Both a higher qCS (adjusted common odds ratio [acOR] per 10% increase: 1.06, 95% CI 1.03-1.09) and shorter time to recanalization (acOR per 30 minutes: 1.17, 95% CI 1.13-1.22) were independently associated with a shift toward better functional outcome. The qCS did not modify the relation between time to recanalization and functional outcome (p for interaction: 0.28). Results from sensitivity analyses using the vCS were similar. DISCUSSION: In the first 6.5 hours of ischemic stroke caused by carotid terminus or M1 occlusion, the collateral status is unaffected by time to imaging, and the benefit of a shorter time to recanalization is independent of baseline collateral status.
BACKGROUND AND OBJECTIVES: In patients with ischemic stroke undergoing endovascular treatment (EVT), time to treatment and collateral status are important prognostic factors and may be correlated. We aimed to assess the relation between time to CT angiography (CTA) and a quantitatively determined collateral score and to assess whether the collateral score modified the relation between time to recanalization and functional outcome. METHODS: We analyzed data from patients with acute ischemic stroke included in the Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke Registry between 2014 and 2017, who had a carotid terminus or M1 occlusion and were treated with EVT within 6.5 hours of symptom onset. A quantitative collateral score (qCS) was determined from baseline CTA using a validated automated image analysis algorithm. We also determined a 4-point visual collateral score (vCS). Multivariable regression models were used to assess the relations between time to imaging and the qCS and between the time to recanalization and functional outcome (90-day modified Rankin Scale score). An interaction term (time to recanalization × qCS) was entered in the latter model to test whether the qCS modifies this relation. Sensitivity analyses were performed using the vCS. RESULTS: We analyzed 1,813 patients. The median time from symptom onset to CTA was 91 minutes (interquartile range [IQR] 65-150 minutes), and the median qCS was 49% (IQR 25%-78%). Longer time to CTA was not associated with the log-transformed qCS (adjusted β per 30 minutes, 0.002, 95% CI -0.006 to 0.011). Both a higher qCS (adjusted common odds ratio [acOR] per 10% increase: 1.06, 95% CI 1.03-1.09) and shorter time to recanalization (acOR per 30 minutes: 1.17, 95% CI 1.13-1.22) were independently associated with a shift toward better functional outcome. The qCS did not modify the relation between time to recanalization and functional outcome (p for interaction: 0.28). Results from sensitivity analyses using the vCS were similar. DISCUSSION: In the first 6.5 hours of ischemic stroke caused by carotid terminus or M1 occlusion, the collateral status is unaffected by time to imaging, and the benefit of a shorter time to recanalization is independent of baseline collateral status.
Authors: Bijoy K Menon; Christopher D d'Esterre; Emmad M Qazi; Mohammed Almekhlafi; Leszek Hahn; Andrew M Demchuk; Mayank Goyal Journal: Radiology Date: 2015-01-29 Impact factor: 11.105
Authors: Maxim Jhl Mulder; Robert-Jan B Goldhoorn; Ido R van den Wijngaard; Charles Blm Majoie; Ivo Gh Jansen; Anna Mm Boers; Adriaan Cgm van Es; Lonneke Sf Yo; Jeannette Hofmeijer; Jasper M Martens; Marianne Aa van Walderveen; Bas Fw van der Kallen; Sjoerd Fm Jenniskens; Kilian M Treurniet; Henk A Marquering; Marieke Es Sprengers; Wouter J Schonewille; Joost Cj Bot; Geert J Lycklama A Nijeholt; Hester F Lingsma; David S Liebeskind; Jelis Boiten; Jan Albert Vos; Yvo Bwem Roos; Robert J van Oostenbrugge; Aad van der Lugt; Wim H van Zwam; Diederik Wj Dippel Journal: J Neurointerv Surg Date: 2019-02-18 Impact factor: 5.836
Authors: David S Liebeskind; Reza Jahan; Raul G Nogueira; Tudor G Jovin; Helmi L Lutsep; Jeffrey L Saver Journal: J Neurointerv Surg Date: 2015-05-11 Impact factor: 5.836
Authors: Elizabeth A Noser; Hashem M Shaltoni; Christiana E Hall; Andrei V Alexandrov; Zsolt Garami; Edwin D Cacayorin; Joon K Song; James C Grotta; Morgan S Campbell Journal: Stroke Date: 2004-12-29 Impact factor: 7.914
Authors: I Y L Tan; A M Demchuk; J Hopyan; L Zhang; D Gladstone; K Wong; M Martin; S P Symons; A J Fox; R I Aviv Journal: AJNR Am J Neuroradiol Date: 2009-01-15 Impact factor: 3.825
Authors: James E Faber; William M Chilian; Elisabeth Deindl; Niels van Royen; Michael Simons Journal: Arterioscler Thromb Vasc Biol Date: 2014-07-10 Impact factor: 8.311
Authors: Simon Jung; Marc Gilgen; Johannes Slotboom; Marwan El-Koussy; Christoph Zubler; Claus Kiefer; Rudolf Luedi; Marie-Luise Mono; Mirjam R Heldner; Anja Weck; Pasquale Mordasini; Gerhard Schroth; Heinrich P Mattle; Marcel Arnold; Jan Gralla; Urs Fischer Journal: Brain Date: 2013-09-24 Impact factor: 13.501
Authors: Sven P R Luijten; Lennard Wolff; Martijne H C Duvekot; Pieter-Jan van Doormaal; Walid Moudrous; Henk Kerkhoff; Geert J Lycklama A Nijeholt; Reinoud P H Bokkers; Lonneke S F Yo; Jeannette Hofmeijer; Wim H van Zwam; Adriaan C G M van Es; Diederik W J Dippel; Bob Roozenbeek; Aad van der Lugt Journal: J Neurointerv Surg Date: 2021-08-19 Impact factor: 8.572
Authors: Smriti Agarwal; Tomasz Matys; S Tulasi Marrapu; Daniel J Scoffings; Jennifer Mitchell; P Simon Jones; Jean-Claude Baron; Elizabeth A Warburton Journal: Front Neurol Date: 2015-04-09 Impact factor: 4.003
Authors: Esmee Venema; Bob Roozenbeek; Maxim J H L Mulder; Scott Brown; Charles B L M Majoie; Ewout W Steyerberg; Andrew M Demchuk; Keith W Muir; Antoni Dávalos; Peter J Mitchell; Serge Bracard; Olvert A Berkhemer; Geert J Lycklama À Nijeholt; Robert J van Oostenbrugge; Yvo B W E M Roos; Wim H van Zwam; Aad van der Lugt; Michael D Hill; Philip White; Bruce C V Campbell; Francis Guillemin; Jeffrey L Saver; Tudor G Jovin; Mayank Goyal; Diederik W J Dippel; Hester F Lingsma Journal: Stroke Date: 2021-07-16 Impact factor: 7.914