You are here

  • Home
  • Archive
  • Volume 11, Issue 9
  • Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry

Article Text

Article menu
Download PDFPDF
Ischemic Stroke
Original research
Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry
  1. Ivo GH Jansen1,
  2. Maxim JHL Mulder2,
  3. Robert-Jan B Goldhoorn3,
  4. Anna MM Boers1,4,
  5. Adriaan CGM van Es5,
  6. Lonneke SF Yo6,
  7. Jeannette Hofmeijer7,
  8. Jasper M Martens8,
  9. Marianne AA van Walderveen9,
  10. Bas FW van der Kallen10,
  11. Sjoerd FM Jenniskens11,
  12. Kilian M Treurniet1,
  13. Henk A Marquering1,4,
  14. Marieke ES Sprengers1,
  15. Wouter J Schonewille12,
  16. Joost CJ Bot13,
  17. Geert J Lycklama a Nijeholt14,
  18. Hester F Lingsma15,
  19. David S Liebeskind16,
  20. Jelis Boiten10,
  21. Jan Albert Vos17,
  22. Yvo BWEM Roos18,
  23. Robert J van Oostenbrugge3,
  24. Aad van der Lugt5,
  25. Wim H van Zwam19,
  26. Diederik WJ Dippel2,
  27. Ido R van den Wijngaard10,
  28. Charles BLM Majoie1
  29. on behalf of the MR CLEAN Registry investigators
    1. 1 Radiology & Nuclear Medicine, Amsterdam University Medical Center (AMC), Amsterdam, The Netherlands
    2. 2 Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
    3. 3 Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
    4. 4 Biomedical Engineering & Physics, Amsterdam University Medical Center (AMC), Amsterdam, The Netherlands
    5. 5 Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
    6. 6 Radiology, Catharina Hospital, Eindhoven, The Netherlands
    7. 7 Neurology, Rijnstate Hospital, Arnhem, The Netherlands
    8. 8 Radiology, Rijnstate Hospital, Arnhem, The Netherlands
    9. 9 Radiology, Leiden University Medical Center, Leiden, The Netherlands
    10. 10 Neurology, Haaglanden Medical Center, The Hague, The Netherlands
    11. 11 Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
    12. 12 Neurology, Sint Antonius Hospital, Nieuwegein, The Netherlands
    13. 13 Radiology, Amsterdam University Medical Center (VUMC), Amsterdam, The Netherlands
    14. 14 Radiology, Haaglanden Medical Center, The Hague, The Netherlands
    15. 15 Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
    16. 16 Neurology, UCLA, Los Angeles, California, USA
    17. 17 Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
    18. 18 Neurology, Amsterdam University Medical Center (AMC), Amsterdam, The Netherlands
    19. 19 Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
    1. Correspondence to Dr. Ivo GH Jansen, Radiology and Nuclear Medicine, AMC, Amsterdam 1105 AZ, The Netherlands; ijansen{at}nico-lab.com

    Abstract

    Background Collateral status modified the effect of endovascular treatment (EVT) for stroke in several randomized trials. We assessed the association between collaterals and functional outcome in EVT treated patients and investigated if this association is time dependent.

    Methods We included consecutive patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) Registry (March 2014–June 2016) with an anterior circulation large vessel occlusion undergoing EVT. Functional outcome was measured on the modified Rankin Scale (mRS) at 90 days. We investigated the association between collaterals and mRS in the MR CLEAN Registry with ordinal logistic regression and if this association was time dependent with an interaction term. Additionally, we determined modification of EVT effect by collaterals compared with MR CLEAN controls, and also investigated if this was time dependent with multiplicative interaction terms.

    Results 1412 patients were analyzed. Functional independence (mRS score of 0–2) was achieved in 13% of patients with grade 0 collaterals, in 27% with grade 1, in 46% with grade 2, and in 53% with grade 3. Collaterals were significantly associated with mRS (adjusted common OR 1.5 (95% CI 1.4 to 1.7)) and significantly modified EVT benefit (P=0.04). None of the effects were time dependent. Better collaterals corresponded to lower mortality (P<0.001), but not to lower rates of symptomatic intracranial hemorrhage (P=0.14).

    Conclusion In routine clinical practice, better collateral status is associated with better functional outcome and greater treatment benefit in EVT treated acute ischemic stroke patients, independent of time to treatment. Within the 6 hour time window, a substantial proportion of patients with absent and poor collaterals can still achieve functional independence.

    • stroke
    • intervention
    • ct angiography

    https://doi.org/10.1136/neurintsurg-2018-014619

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      View Full Text

      Footnotes

      • MJHLM and R-JBG contributed equally.

      • IRW and CBLMM contributed equally.

      • Contributors IGHJ prepared the first draft. IGHJ, MJHLM, IRW ,and HFL designed the study and performed the statistical analyses. IGHJ, MJHLM, R-JBG, AMMB, KT, DWJD, CBLMM, IRW, and DL participated in the study design, data collection, data analysis, interpretation, and writing of the manuscript. GJLN, MW, MS, SJ, BK, IRW, ACGME, and LY participated in the data analysis. All authors participated in patient enrolment and data collection, critically reviewed the manuscript, and approved the final version. MJHLM and R-JBG contributed equally, as did IRW and CBLMM.

      • Funding This study was supported by an unrestricted grant from the TWIN Foundation (Toegepast Wetenschappelijk Instituut voor Neuromodulatie; http://www.stichtingtwin.nl/).

      • Competing interests All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf. IGHJ owns stock in Nico lab BV, a company that focuses on the use of artificial intelligence for medical image analysis (https://www.nico-lab.com/). CBLMM reports grants from the TWIN Foundation, during the conduct of the study; grants from CVON/Dutch Heart Foundation, grants from Stryker, outside the submitted work (paid to institution); and owns stock in Nico lab BV. YBWEMR owns stock in Nico lab BV. WHZ reports personal fees from Codman and personal fees from Stryker, outside the submitted work. AL reports consulting fees from Stryker, outside the submitted work. DWJD reports grants from the Dutch Heart Foundation, AngioCare BV, Medtronic/Covidien/EV3, MEDAC Gmbh/LAMEPRO, Penumbra Inc, Top Medical/Concentric, and Stryker, during conduct of the study; and consultation fees from Stryker, Bracco Imaging, and Servier, received by the Erasmus University Medical Center, outside the submitted work. DL reports consultation fees from Stryker and Medtronic, outside the submitted work. AMMB and HAM report owning stock in Nico lab BV. All other authors did not receive support from any organization for the submitted work, had no financial relationships with any organizations that might have an interest in the submitted work in the previous three years and had no other relationships or activities that could appear to have influenced the submitted work.

      • Ethics approval The study protocol was evaluated by the central medical ethics committee of the Erasmus University Medical Center, Rotterdam, The Netherlands. Permission to carry out the study as a registry was granted.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Collaborators Executive committee: Diederik W J Dippel (Department of Neurology, Erasmus MC University Medical Center), Aad van der Lugt (Department of Radiology, Erasmus MC University Medical Center), Charles B L M Majoie (Department of Radiology, Academic Medical Center, Amsterdam), Yvo B W E M Roos (Department of Neurology, Academic Medical Center, Amsterdam), Robert J van Oostenbrugge (Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)), Wim H van Zwam (Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)), Jelis Boiten (Department of Neurology, MC Haaglanden, the Hague), Jan-Albert Vos (Department of Radiology, Sint Antonius Hospital, Nieuwegein). Study coordinators: Ivo G H Jansen (Department of Radiology, Academic Medical Center, Amsterdam), Maxim J H L Mulder (Department of Neurology, Erasmus MC University Medical Center, Department of Radiology, Erasmus MC University Medical Center), Robert-Jan B Goldhoorn (Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)). Local principal investigators: Wouter J Schonewille (Department of Neurology, St Antonius Hospital, Nieuwegein), Jan Albert Vos (Department of Radiology, St Antonius Hospital, Nieuwegein), Charles B L M Majoie (Department of Radiology, Academic Medical Center, Amsterdam), Jonathan M Coutinho (Department of Neurology, Academic Medical Center, Amsterdam), Marieke J H Wermern (Department of Neurology, Leiden University Medical Center), Marianne A A van Walderveen (Department of Radiology, Leiden University Medical Center), Julie Staals (Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)), Wim H van Zwam (Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)), Jeannette Hofmeijer (Department of Neurology, Rijnstate Hospital, Arnhem), Jasper M Martens (Department of Radiology, Rijnstate Hospital, Arnhem), Geert J Lycklama à Nijeholt (Department of Radiology, MC Haaglanden, the Hague), Jelis Boiten (Department of Neurology, MC Haaglanden, the Hague), Bob Roozenbeek (Department of Neurology, Erasmus MC University Medical Center), Bart J Emmer (Department of Radiology, Erasmus MC University Medical Center), Sebastiaan F de Bruijn (Department of Neurology, HAGA Hospital, the Hague), Lukas C van Dijk (Department of Radiology, HAGA Hospital, the Hague), H Bart van der Worp (Department of Neurology, University Medical Center Utrecht), Rob H Lo (Department of Radiology, University Medical Center Utrecht), Ewoud J van Dijk (Department of Neurology, Radboud University Medical Center, Nijmegen), Hieronymus D Boogaarts (Department of Neurosurgery, Radboud University Medical Center, Nijmegen), Paul L M de Kort (Department of Neurology, Sint Elisabeth Hospital, Tilburg), Jo J P Peluso (Department of Radiology, Sint Elisabeth Hospital, Tilburg), Jan S P van den Berg (Department of Neurology, Isala Klinieken, Zwolle), Boudewijn A A M van Hasselt (Department of Radiology, Isala Klinieken, Zwolle), Leo A M Aerden (Department of Neurology, Reinier de Graaf Gasthuis, Delft), René J Dallinga (Department of Radiology, Reinier de Graaf Gasthuis, Delft), Maarten Uyttenboogaart (Department of Neurology, University Medical Center Groningen), Omid Eshghi (Department of Radiology, University Medical Center Groningen), Tobien H C M L Schreuder (Department of Neurology, Atrium Medical Center, Heerlen), Roel J J Heijboer (Department of Radiology, Atrium Medical Center, Heerlen), Koos Keizer (Department of Neurology, Catharina Hospital, Eindhoven), Lonneke S F Yo (Department of Radiology, Catharina Hospital, Eindhoven), Heleen M den Hertog (Department of Neurology, Medical Spectrum Twente, Enschede), Emiel J C Sturm (Department of Radiology, Medical Spectrum Twente, Enschede). Imaging assessment committee: Charles B L M Majoie (chair) (Department of Radiology, Academic Medical Center, Amsterdam), Wim H van Zwam, Aad van der Lugt (Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)), Geert J Lycklama à Nijeholt (Department of Radiology, MC Haaglanden, the Hague), Marianne A A van Walderveen (Department of Radiology, Leiden University Medical Center), Marieke E S Sprengers (Department of Radiology, Academic Medical Center, Amsterdam), Sjoerd F M Jenniskens (Department of Radiology, Radboud University Medical Center, Nijmegen), René van den Berg (Department of Radiology, Academic Medical Center, Amsterdam), Albert J Yoo ((Department of Radiology, Texas Stroke Institute, Texas, United States of America)), Ludo F M Beenen (Department of Radiology, Academic Medical Center, Amsterdam), Stefan D Roosendaal (Department of Radiology, Academic Medical Center, Amsterdam), Bas F W van der Kallen (Department of Radiology, MC Haaglanden, the Hague), Ido R van den Wijngaard (Department of Radiology, MC Haaglanden, the Hague), Ad van Es (Department of Radiology, Erasmus MC University Medical Center), Bart Emmer (Department of Radiology, Erasmus MC University Medical Center, Department of Radiology, Academic Medical Center, Amsterdam), Jasper M Martens (Department of Radiology, Rijnstate Hospital, Arnhem), Lonneke S F Yo (Department of Radiology, Catharina Hospital, Eindhoven), Jan Albert Vos (Department of Radiology, St Antonius Hospital, Nieuwegein), Joost Bot (Department of Radiology, VUMC, Amsterdam), Pieter-Jan van Doormaal (Department of Radiology, Erasmus MC University Medical Center). Writing committee: Diederik W J Dippel (chair) (Department of Neurology, Erasmus MC University Medical Center), Aad van der Lugt (Department of Radiology, Erasmus MC University Medical Center), Charles B L M Majoie (Department of Radiology, Academic Medical Center, Amsterdam), Yvo B W E M Roos Department of Neurology, Academic Medical Center, Amsterdam), Robert J van Oostenbrugge (Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)), Wim H van Zwam (Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)), Geert J Lycklama à Nijeholt (Department of Radiology, MC Haaglanden, the Hague), Jelis Boiten (Department of Neurology, MC Haaglanden, the Hague), Jan Albert Vos (Department of Radiology, Sint Antonius Hospital, Nieuwegein), Wouter J Schonewille (Department of Neurology, Sint Antonius Hospital, Nieuwegein), Jeannette Hofmeijer (Department of Neurology, Rijnstate Hospital, Arnhem), Jasper M Martens (Department of Radiology, Rijnstate Hospital, Arnhem), H Bart van der Worp (Department of Neurology, University Medical Center Utrecht), Rob H Lo (Department of Radiology, University Medical Center Utrecht). Adverse event committee: Robert J van Oostenbrugge (chair) (Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)), Jeannette Hofmeijer (Department of Neurology, Rijnstate Hospital, Arnhem), H Zwenneke Flach (Department of Radiology, Isala Klinieken, Zwolle). Trial methodologist: Hester F Lingsma (Department of Public Health, Erasmus MC University Medical Center), Research nurses / local trial coordinators: Naziha el Ghannouti (Department of Neurology, Erasmus MC University Medical Center), Martin Sterrenberg (Department of Neurology, Erasmus MC University Medical Center), Corina Puppels (Department of Neurology, St Antonius Hospital, Nieuwegein), Wilma Pellikaan (Department of Neurology, St Antonius Hospital, Nieuwegein), Rita Sprengers (Department of Radiology, Academic Medical Center, Amsterdam), Marjan Elfrink (Department of Neurology, Rijnstate Hospital, Arnhem), Joke de Meris (Department of Neurology, MC Haaglanden, the Hague), Tamara Vermeulen (Department of Neurology, MC Haaglanden, the Hague), Annet Geerlings (Department of Neurology, Radboud University Medical Center, Nijmegen), Gina van Vemde (Department of Neurology, Isala Klinieken, Zwolle), Tiny Simons (Department of Neurology, Atrium Medical Center, Heerlen), Cathelijn van Rijswijk (Department of Neurology, St Elisabeth Hospital, Tilburg), Gert Messchendorp (Department of Neurology, University Medical Center Groningen), Hester Bongenaar (Department of Neurology, Catharina Hospital, Eindhoven), Karin Bodde (Department of Neurology, Reinier de Graaf Gasthuis, Delft), Sandra Kleijn (Department of Neurology, Medical Spectrum Twente, Enschede), Jasmijn Lodico (Department of Neurology, Medical Spectrum Twente, Enschede), Hanneke Droste (Department of Neurology, Medical Spectrum Twente, Enschede), M Wollaert, D Jeurrissen (Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)), Erna Bos (Department of Neurology, Leiden University Medical Center), Yvonne Drabbe (Department of Neurology, HAGA Hospital, the Hague), Berber Zweedijk (Department of Neurology, University Medical Center Utrecht), Mostafa Khalilzada (Department of Neurology, HAGA Hospital, the Hague). PhD / Medical students: Esmee Venema (Department of Neurology, Erasmus MC University Medical Center, Department of Public Health, Erasmus MC University Medical Center), Vicky Chalos (Department of Public Health, Erasmus MC University Medical Center), Kars J Compagne (Department of Radiology, Erasmus MC University Medical Center), Ralph R Geuskens (Department of Radiology, Academic Medical Center, Amsterdam), Tim van Straaten (Department of Neurology, Radboud University Medical Center, Nijmegen), Saliha Ergezen (Department of Neurology, Erasmus MC University Medical Center), Roger R M Harmsma (Department of Neurology, Erasmus MC University Medical Center), Daan Muijres (Department of Neurology, Erasmus MC University Medical Center), Anouk de Jong (Department of Neurology, Erasmus MC University Medical Center), Wouter Hinseveld (Department of Neurology, Sint Antonius Hospital, Nieuwegein), Olvert A Berkhemer (Department of Neurology, Erasmus MC University Medical Center,Department of Radiology, Academic Medical Center, Amsterdam, Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)), Anna M M Boers (Department of Radiology, Academic Medical Center, Amsterdam, Department of Biomedical Engineering & Physics, Academic Medical Center, Amsterdam), J Huguet (Department of Radiology, Academic Medical Center, Amsterdam), P F C Groot (Department of Radiology, Academic Medical Center, Amsterdam), Marieke A Mens (Department of Radiology, Academic Medical Center, Amsterdam), Katinka R van Kranendonk (Department of Radiology, Academic Medical Center, Amsterdam), Kilian M Treurniet (Department of Radiology, Academic Medical Center, Amsterdam), Manon Kappelhof (Department of Radiology, Academic Medical Center, Amsterdam), Manon L Tolhuijsen (Department of Radiology, Academic Medical Center, Amsterdam0, Heitor Alves (Department of Radiology, Academic Medical Center, Amsterdam).

      • Patient consent for publication Not required.