title: Collateral status and tissue outcome after intra-arterial therapy for patients with acute ischemic stroke.
abstract: 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.
authors.affiliation: 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.
authors.forename: Anna Mm
authors.initials: AM
authors.lastname: Boers
authors.affiliation: 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.|3 Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Ivo Gh
authors.initials: IG
authors.lastname: Jansen
authors.affiliation: 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.
authors.forename: Olvert A
authors.initials: OA
authors.lastname: Berkhemer
authors.affiliation: 6 Division of Neurointervention, Texas Stroke Institute, Dallas, TX, USA.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.affiliation: 7 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.affiliation: 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.
authors.forename: Cornelis H
authors.initials: CH
authors.lastname: Slump
authors.affiliation: 9 Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Yvo Bwem
authors.initials: YB
authors.lastname: Roos
authors.affiliation: 10 Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Oostenbrugge
authors.affiliation: 4 Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Diederik Wj
authors.initials: DW
authors.lastname: Dippel
authors.affiliation: 11 Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.affiliation: 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.
authors.forename: Wim H
authors.initials: WH
authors.lastname: van Zwam
authors.affiliation: 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.|3 Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
authors.affiliation: 1 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Charles Blm
authors.initials: CB
authors.lastname: Majoie
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000473:pathology; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute ischemic stroke; collateral circulation; final infarct volume; intra-arterial therapy; treatment effect