title: Favorable vascular profile is an independent predictor of outcome: a post hoc analysis of the safety and efficacy of NeuroFlo Technology in Ischemic Stroke trial.
abstract: OBJECTIVE
  We hypothesized that a favorable vascular profile (FVP) defined as anatomic intactness of the Circle of Willis combined with a stable cerebral perfusion pressure (mean arterial blood pressure>65 mm Hg) is a prerequisite for collateral recruitment and maintenance and may improve outcome. We performed post hoc analyses of a subset of the Safety and Efficacy of NeuroFlo Technology in Ischemic Stroke (SENTIS) trial data set to identify whether FVP is associated with independent outcome.
  
  
  METHODS
  SENTIS was a randomized, controlled device trial comparing hemodynamic augmentation with the NeuroFlo device to best medical treatment. We identified all patients from the primary dataset (n=515 patients) with available intracranial vascular imaging at baseline. Vascular imaging data were read blind to clinical and treatment data. We performed univariate and multivariate analyses to identify predictors of independent outcome (modified Rankin Scale 0-2) at 90 days.
  
  
  RESULTS
  A total of 192/515 SENTIS subjects had available baseline vascular imaging (91 treated/101 controls). Baseline characteristics did not differ between groups. Overall, FVP was seen in 89.6% of patients and predicted independent outcome in univariate (odds ratio, 7.46; 95% confidence interval, 1.68-33.18; P=0.0082) and multiple logistic regression analyses (odds ratio, 10.22; 95% confidence interval, 1.78-58.57; P=0.0091). Aside from FVP, only baseline National Institutes of Health Stroke Scales (NIHSS; odds ratio, 0.74; 95% confidence interval, 0.67-0.82, P<0.0001) entered the predictive model. There was no interaction with randomization to treatment or control.
  
  
  CONCLUSIONS
  FVP and baseline NIHSS independently predicted outcome in this subset of the SENTIS population. FVP is a novel parameter to predict outcome of acute stroke patients and further studies will establish its potential role for selection of optimal candidates for hemodynamic augmentation. Clinical Trial Registration Information- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00119717.
authors.affiliation: Departments of Neurology and Neurogeriatry, Johannes Wesling Klinikum, Minden, Hans-Nolte-Str 1, D-32429 Minden, Germany. peter.schellinger@muehlenkreiskliniken.de
authors.forename: Peter D
authors.initials: PD
authors.lastname: Schellinger
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.forename: Songling
authors.initials: S
authors.lastname: Liu
authors.forename: William P
authors.initials: WP
authors.lastname: Dillon
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000792:Angiography; D001012:Aorta, Abdominal / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002941:Circle of Willis / Q000000981:diagnostic imaging / Q000502:physiology*; D004869:Equipment Safety / Q000592:standards*; D004864:Equipment and Supplies / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology*; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D060205:Therapeutic Occlusion / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
keywords: SENTIS; aortic occlusion; brain perfusion augmentation; clinical trials; ischemic stroke
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