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Arterial Collaterals and Endovascular Treatment Effect in Acute Ischemic Stroke with Large Infarct: A Secondary Analysis of the TENSION Trial

L. Winkelmeier, H. Kniep, G. Thomalla, M. Bendszus, F. Subtil, S. Bonekamp, AH. Aamodt, B. Fuentes, ER. Gizewski, MD. Hill, A. Krajina, L. Pierot, CZ. Simonsen, K. Zeleňák, RA. Blauenfeldt, B. Cheng, A. Denis, H. Deutschmann, F. Dorn, S....

. 2025 ; 314 (2) : e242401. [pub] -

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, randomizované kontrolované studie, multicentrická studie

Perzistentní odkaz   https://www.medvik.cz/link/bmc25009976

Background Randomized clinical trials have demonstrated that endovascular thrombectomy reduces functional disability in patients with large ischemic stroke; arterial collateral status might be used to select these patients for endovascular thrombectomy. Purpose To investigate whether arterial collateral status modifies the treatment effect of endovascular thrombectomy in patients with large ischemic stroke. Materials and Methods The Efficacy and Safety of Thrombectomy in Stroke with Extended Lesion and Extended Time Window (TENSION) trial was a prospective, multicenter, randomized study investigating participants with acute large ischemic stroke due to anterior circulation large-vessel occlusion. Participants with an Alberta Stroke Program Early CT Score of 3-5 were enrolled at 41 participating centers between July 2018 and February 2023. Participants were randomly assigned to undergo either endovascular thrombectomy with best medical treatment or best medical treatment alone within 12 hours from stroke onset. Collateral status was graded on pretreatment single-phase CT angiography (CTA) images using the Tan score and dichotomized into poor (grade, 0-1) or good (grade, 2-3) based on the extent of collateral supply filling the affected middle cerebral artery territory. The primary outcome was the shift on the 90-day modified Rankin Scale (mRS). Results Of 253 randomized patients, 201 with pretreatment CTA were included (median age, 74 years; IQR, 66-80 years; 103 [51.2%] female patients; 103 [51.2%] patients underwent endovascular thrombectomy). Endovascular thrombectomy compared with best medical treatment (adjusted common odds ratio [OR], 3.69; 95% CI: 2.12, 6.54; P < .001) and good collaterals compared with poor collaterals (adjusted common OR, 2.88; 95% CI: 1.63, 5.11; P < .001) were independently associated with a shift in the 90-day mRS scores toward better functional outcomes. The treatment effect of endovascular thrombectomy over best medical treatment was not modified by collateral status (interaction, P = .88). The treatment effect of endovascular thrombectomy versus best medical treatment was found in patients with good collaterals (adjusted common OR, 3.93; 95% CI: 1.65, 9.69; P = .002) and poor collaterals (adjusted common OR, 3.92; 95% CI: 1.86, 8.52; P < .001). Conclusion In this secondary analysis of data from the TENSION trial, endovascular thrombectomy reduced 90-day functional disability compared with best medical treatment in patients with good and poor collaterals. These findings suggest that patients with large ischemic stroke manifesting within 12 hours after onset should undergo endovascular thrombectomy irrespective of single-phase CTA collateral status. ClinicalTrials.gov Identifier: NCT03094715 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Benomar and Raymond in this issue.

Biostatistics Department Hospices Civils de Lyon Lyon France

Clinic and Polyclinic for Neurology Universitätsklinikum Hamburg Eppendorf Hamburg Germany

Clinic and Polyclinic for Neuroradiological Diagnostics and Intervention Universitätsklinikum Hamburg Eppendorf Martinistrasse 52 20251 Hamburg Germany

Clinic for Diagnostic and Interventional Neuroradiology Klinikum Bremen Mitte Bremen Germany

Clinic for Diagnostic and Interventional Neuroradiology Universitätsklinikum Bonn Bonn Germany

Clinic of Neurology Jessenius Faculty of Medicine Comenius University Martin Slovakia

Clinic of Radiology Jessenius Faculty of Medicine Comenius University Martin Slovakia

Department of Clinical Neurosciences Hotchkiss Brain Institute Health Science Centre University of Calgary and Foothills Medical Centre Calgary AB Canada

Department of Medical Imaging St Anne's University Hospital Brno and Faculty of Medicine Masaryk University Brno Czech Republic

Department of Neurology Aarhus University Hospital Aarhus Denmark

Department of Neurology and Stroke Center Hospital La Paz Institute for Health Research La Paz University Hospital Universidad Autónoma de Madrid Madrid Spain

Department of Neurology Faculty Hospital Trnava Trnava Slovakia

Department of Neurology Faculty of Medicine in Hradec Kralove Charles University Czech Republic

Department of Neurology Hôpital Maison Blanche Université Reims Champagne Ardenne Reims France

Department of Neurology Klinikum Bremen Mitte Bremen Germany

Department of Neurology Oslo University Hospital Oslo Norway and the Norwegian University of Science and Technology Trondheim Norway

Department of Neurology Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden Dresden Germany

Department of Neuroradiology Hôpital Maison Blanche Université Reims Champagne Ardenne Reims France

Department of Neuroradiology Medical University Innsbruck Innsbruck Austria

Department of Neuroradiology Oslo University Hospital Oslo Norway

Department of Radiology Aretaieion University Hospital National and Kapodistrian University of Athens Athens Greece

Department of Radiology Faculty Hospital Trnava Trnava Slovakia

Department of Radiology Faculty of Medicine in Hradec Kralove Charles University Czech Republic

Department of Radiology Section of Neuroradiology Aarhus University Hospital Aarhus Denmark

Department of Vascular Neurology University Hospital Bonn Bonn Germany

Division of Neuroradiology Vascular and Interventional Radiology Department of Radiology Medical University Graz Graz Austria

Dortmund Clinic Klinikum der Universität Witten Herdecke Dortmund Germany

Dresden Neurovascular Center Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden Dresden Germany

Eppdata Hamburg Germany

Institute of Diagnostic and Interventional Neuroradiology Universitätsklinikum Würzburg Würzburg Germany

Institute of Diagnostic and Interventional Radiology and Neuroradiology DIAKO Krankenhaus Flensburg Germany

Institute of Neuroradiology Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden Dresden Germany

Institute of Neuroradiology Universitätsklinikum Frankfurt Frankfurt am Main Germany

Laboratory of Biometrics and Evolutionary Biology Université Lyon 1 Villeurbanne France

Neurology Universitätsklinikum Universität Heidelberg Heidelberg Germany

Neuroradiology Universitätsklinikum Heidelberg Heidelberg Germany

Vascular Neurology Research Group German Center for Neurodegenerative Diseases Bonn Germany

Citace poskytuje Crossref.org

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$a Arterial Collaterals and Endovascular Treatment Effect in Acute Ischemic Stroke with Large Infarct: A Secondary Analysis of the TENSION Trial / $c L. Winkelmeier, H. Kniep, G. Thomalla, M. Bendszus, F. Subtil, S. Bonekamp, AH. Aamodt, B. Fuentes, ER. Gizewski, MD. Hill, A. Krajina, L. Pierot, CZ. Simonsen, K. Zeleňák, RA. Blauenfeldt, B. Cheng, A. Denis, H. Deutschmann, F. Dorn, S. Gellissen, JC. Gerber, M. Goyal, J. Haring, C. Herweh, S. Hopf-Jensen, VT. Hua, M. Jensen, A. Kastrup, CF. Keil, A. Klepanec, E. Kurča, R. Mikkelsen, M. Möhlenbruch, S. Müller-Hülsbeck, N. Münnich, P. Pagano, P. Papanagiotou, GC. Petzold, M. Pham, V. Puetz, J. Raupach, G. Reimann, PA. Ringleb, M. Schell, E. Schlemm, S. Schönenberger, B. Tennøe, C. Ulfert, K. Vališ, E. Vítková, DF. Vollherbst, W. Wick, J. Fiehler, F. Flottmann, TENSION Investigators
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$a Background Randomized clinical trials have demonstrated that endovascular thrombectomy reduces functional disability in patients with large ischemic stroke; arterial collateral status might be used to select these patients for endovascular thrombectomy. Purpose To investigate whether arterial collateral status modifies the treatment effect of endovascular thrombectomy in patients with large ischemic stroke. Materials and Methods The Efficacy and Safety of Thrombectomy in Stroke with Extended Lesion and Extended Time Window (TENSION) trial was a prospective, multicenter, randomized study investigating participants with acute large ischemic stroke due to anterior circulation large-vessel occlusion. Participants with an Alberta Stroke Program Early CT Score of 3-5 were enrolled at 41 participating centers between July 2018 and February 2023. Participants were randomly assigned to undergo either endovascular thrombectomy with best medical treatment or best medical treatment alone within 12 hours from stroke onset. Collateral status was graded on pretreatment single-phase CT angiography (CTA) images using the Tan score and dichotomized into poor (grade, 0-1) or good (grade, 2-3) based on the extent of collateral supply filling the affected middle cerebral artery territory. The primary outcome was the shift on the 90-day modified Rankin Scale (mRS). Results Of 253 randomized patients, 201 with pretreatment CTA were included (median age, 74 years; IQR, 66-80 years; 103 [51.2%] female patients; 103 [51.2%] patients underwent endovascular thrombectomy). Endovascular thrombectomy compared with best medical treatment (adjusted common odds ratio [OR], 3.69; 95% CI: 2.12, 6.54; P < .001) and good collaterals compared with poor collaterals (adjusted common OR, 2.88; 95% CI: 1.63, 5.11; P < .001) were independently associated with a shift in the 90-day mRS scores toward better functional outcomes. The treatment effect of endovascular thrombectomy over best medical treatment was not modified by collateral status (interaction, P = .88). The treatment effect of endovascular thrombectomy versus best medical treatment was found in patients with good collaterals (adjusted common OR, 3.93; 95% CI: 1.65, 9.69; P = .002) and poor collaterals (adjusted common OR, 3.92; 95% CI: 1.86, 8.52; P < .001). Conclusion In this secondary analysis of data from the TENSION trial, endovascular thrombectomy reduced 90-day functional disability compared with best medical treatment in patients with good and poor collaterals. These findings suggest that patients with large ischemic stroke manifesting within 12 hours after onset should undergo endovascular thrombectomy irrespective of single-phase CTA collateral status. ClinicalTrials.gov Identifier: NCT03094715 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Benomar and Raymond in this issue.
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