Arterial Collaterals and Endovascular Treatment Effect in Acute Ischemic Stroke with Large Infarct: A Secondary Analysis of the TENSION Trial
Jazyk angličtina Země Spojené státy americké Médium print
Typ dokumentu časopisecké články, multicentrická studie, randomizované kontrolované studie
PubMed
39998372
DOI
10.1148/radiol.242401
Knihovny.cz E-zdroje
- MeSH
- CT angiografie * metody MeSH
- endovaskulární výkony * metody MeSH
- ischemická cévní mozková příhoda * chirurgie diagnostické zobrazování patofyziologie MeSH
- kolaterální oběh * fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mozková angiografie MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- trombektomie * metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
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 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 Neurology Aarhus University Hospital Aarhus Denmark
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 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 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
Dortmund Clinic Klinikum der Universität Witten Herdecke Dortmund 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
ClinicalTrials.gov
NCT03094715
