학술논문
Combining Early Ischemic Change and Collateral Extent for Functional Outcomes After Endovascular Therapy: An Analysis From AcT Trial.
Document Type
Academic Journal
Author
Tanaka K; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Kaveeta C; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (C.K.).; Pensato U; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Biomedical Sciences, Humanitas University, Milan, Italy (U.P.).; IRCCS Humanitas Research Hospital, Milan, Italy (U.P.).; Zhang J; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Bala F; Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, France (F.B.).; Alhabli I; Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Horn M; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Ademola A; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada.; Almekhlafi M; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Ganesh A; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada.; Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Buck B; Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (B.B.).; Tkach A; Department of Neurosciences, Kelowna General Hospital, BC, Canada (A.T.).; Catanese L; Department of Medicine, McMaster University, Hamilton, ON, Canada (L.C.).; Dowlatshahi D; Department of Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M.S.).; Shankar J; Department of Radiology, Health Sciences Center (J.S.), University of Manitoba, Winnipeg, Canada.; Poppe AY; Department of Clinical Neurosciences, Université de Montréal, QC, Canada (A.Y.P.).; Shamy M; Department of Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M.S.).; Qiu W; Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan, China (W.Q.).; Swartz RH; Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (R.H.S.).; Hill MD; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada.; Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Medicine (M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada.; Sajobi TT; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada.; Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Menon BK; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Radiology (F.B., I.A., M.A., M.D.H., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Community Health Sciences (A.A., M.A., A.G., M.D.H., T.T.S., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada.; Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Demchuk AM; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Hotchkiss Brain Institute (M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, AB, Canada.; Singh N; Department of Clinical Neurosciences (K.T., C.K., U.P., J.Z., M.H., A.A., M.A., A.G., M.D.H., T.T.S., B.K.M., A.M.D., N.S.), Cumming School of Medicine, University of Calgary, AB, Canada.; Department of Internal Medicine, Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada.
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0235266 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4628 (Electronic) Linking ISSN: 00392499 NLM ISO Abbreviation: Stroke Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Early ischemic change and collateral extent are colinear with ischemic core volume (ICV). We investigated the relationship between a combined score using the Alberta Stroke Program Early Computed Tomography Score and multiphase computed tomography angiography (mCTA) collateral extent, named mCTA-ACE score, on functional outcomes in endovascular therapy-treated patients.
Methods: We performed a post hoc analysis of a subset of endovascular therapy-treated patients from the Alteplase Compared to Tenecteplase trial which was conducted between December 2019 and January 2022 at 22 centers across Canada. Ten-point mCTA collateral corresponding to M2 to M6 regions of the Alberta Stroke Program Early Computed Tomography Score grid was evaluated as 0 (poor), 1 (moderate), or 2 (normal) and additively combined with the 10-point Alberta Stroke Program Early Computed Tomography Score to produce a 20-point mCTA-ACE score. We investigated the association of mCTA-ACE score with modified Rankin Scale score ≤2 and return to prestroke level of function at 90 to 120 days using mixed-effects logistic regression. In the subset of patients who underwent baseline computed tomography perfusion imaging, we compared the mCTA-ACE score and ICV for outcome prediction.
Results: Among 1577 intention-to-treat population in the trial, 368 (23%; 179 men; median age, 73 years) were included, with Alberta Stroke Program Early Computed Tomography Score, mCTA collateral, and combination of both (mCTA-ACE score: median [interquartile range], 8 [7-10], 9 [8-10], and 17 [16-19], respectively). The probability of modified Rankin Scale score ≤2 and return to prestroke level of function increased for each 1-point increase in mCTA-ACE score (odds ratio, 1.16 [95% CI, 1.06-1.28] and 1.22 [95% CI, 1.06-1.40], respectively). Among 173 patients in whom computed tomography perfusion data was assessable, the mCTA-ACE score was inversely correlated with ICV (ρ=-0.46; P <0.01). The mCTA-ACE score was comparable to ICV to predict a modified Rankin Scale score ≤2 and return to prestroke level of function (C statistics 0.71 versus 0.69 and 0.68 versus 0.64, respectively).
Conclusions: The mCTA-ACE score had a significant positive association with functional outcomes after endovascular therapy and had a similar predictive performance as ICV.
Competing Interests: Disclosures Dr Catanese reports compensation from Roche. Dr Shankar reports a grant from Medtronic. Dr Poppe reports grants from the Heart and Stroke Foundation of Canada, the Fondation Brain Canada, and Stryker and compensation from Roche. Dr Swartz reports grants from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada; compensation from Roche and the Sunnybrook Research Institute; and stock holdings in FollowMD, Inc. Dr Hill reports grants from the Canadian Institutes of Health Research, Roche, Medtronic, MicroVention, Inc, Boehringer Ingelheim, and NoNO, Inc; compensation from Brainsgate and Merck; and a patent issued for Systems and Methods for Assisting in Decision-Making and Triaging for Acute Stroke Patients licensed to Circle Neurovascular Imaging. Dr Sajobi reports the role as a consultant to Circle Neurovascular Imaging. Dr Menon reports stock holdings in Circle Neurovascular Imaging and compensation from Roche and Boehringer Ingelheim. Dr Demchuk reports compensation from Roche, Lumosa, Boehringer Ingelheim, NovaSignal, Philips, and Medtronic; stock holdings in Circle Neurovascular Imaging; and a patent issued for Stroke imaging software licensed to Circle Neurovascular Imaging. Dr Ganesh reports grants from the Canadian Institutes of Health Research, the Alzheimer Society of Canada, the Heart and Stroke Foundation of Canada, the Fondation Brain Canada, the Sunnybrook Research Institute, the Canadian Cardiovascular Society, Alberta Innovates, Campus Alberta Neuroscience, the Government of Canada, Wellcome Trust, MicroVention, Inc, and Panmure House; compensation from the Canadian Association of Neuroscience Nurses, Biogen, and Atheneum for consultant services; MD Analytics, Creative Research Designs, CTC Communications, Corporation, Alexion Pharmaceuticals, Figure 1, Rhodes Scholarships, MyMedicalPanel, and DeepBench; and stock holdings in Collavidence, Inc, and SnapDx, Inc. Dr Ganesh is a Review Editor of Stroke for Frontiers in Neurology and an Editorial Board Member of Stroke of the American Heart Association and Neurology and Neurology: Clinical Practice of American Academy of Neurology and reports travel supports from the American Heart Association, the American Academy of Neurology, and the University of Calgary. The other authors report no conflicts.
Methods: We performed a post hoc analysis of a subset of endovascular therapy-treated patients from the Alteplase Compared to Tenecteplase trial which was conducted between December 2019 and January 2022 at 22 centers across Canada. Ten-point mCTA collateral corresponding to M2 to M6 regions of the Alberta Stroke Program Early Computed Tomography Score grid was evaluated as 0 (poor), 1 (moderate), or 2 (normal) and additively combined with the 10-point Alberta Stroke Program Early Computed Tomography Score to produce a 20-point mCTA-ACE score. We investigated the association of mCTA-ACE score with modified Rankin Scale score ≤2 and return to prestroke level of function at 90 to 120 days using mixed-effects logistic regression. In the subset of patients who underwent baseline computed tomography perfusion imaging, we compared the mCTA-ACE score and ICV for outcome prediction.
Results: Among 1577 intention-to-treat population in the trial, 368 (23%; 179 men; median age, 73 years) were included, with Alberta Stroke Program Early Computed Tomography Score, mCTA collateral, and combination of both (mCTA-ACE score: median [interquartile range], 8 [7-10], 9 [8-10], and 17 [16-19], respectively). The probability of modified Rankin Scale score ≤2 and return to prestroke level of function increased for each 1-point increase in mCTA-ACE score (odds ratio, 1.16 [95% CI, 1.06-1.28] and 1.22 [95% CI, 1.06-1.40], respectively). Among 173 patients in whom computed tomography perfusion data was assessable, the mCTA-ACE score was inversely correlated with ICV (ρ=-0.46; P <0.01). The mCTA-ACE score was comparable to ICV to predict a modified Rankin Scale score ≤2 and return to prestroke level of function (C statistics 0.71 versus 0.69 and 0.68 versus 0.64, respectively).
Conclusions: The mCTA-ACE score had a significant positive association with functional outcomes after endovascular therapy and had a similar predictive performance as ICV.
Competing Interests: Disclosures Dr Catanese reports compensation from Roche. Dr Shankar reports a grant from Medtronic. Dr Poppe reports grants from the Heart and Stroke Foundation of Canada, the Fondation Brain Canada, and Stryker and compensation from Roche. Dr Swartz reports grants from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada; compensation from Roche and the Sunnybrook Research Institute; and stock holdings in FollowMD, Inc. Dr Hill reports grants from the Canadian Institutes of Health Research, Roche, Medtronic, MicroVention, Inc, Boehringer Ingelheim, and NoNO, Inc; compensation from Brainsgate and Merck; and a patent issued for Systems and Methods for Assisting in Decision-Making and Triaging for Acute Stroke Patients licensed to Circle Neurovascular Imaging. Dr Sajobi reports the role as a consultant to Circle Neurovascular Imaging. Dr Menon reports stock holdings in Circle Neurovascular Imaging and compensation from Roche and Boehringer Ingelheim. Dr Demchuk reports compensation from Roche, Lumosa, Boehringer Ingelheim, NovaSignal, Philips, and Medtronic; stock holdings in Circle Neurovascular Imaging; and a patent issued for Stroke imaging software licensed to Circle Neurovascular Imaging. Dr Ganesh reports grants from the Canadian Institutes of Health Research, the Alzheimer Society of Canada, the Heart and Stroke Foundation of Canada, the Fondation Brain Canada, the Sunnybrook Research Institute, the Canadian Cardiovascular Society, Alberta Innovates, Campus Alberta Neuroscience, the Government of Canada, Wellcome Trust, MicroVention, Inc, and Panmure House; compensation from the Canadian Association of Neuroscience Nurses, Biogen, and Atheneum for consultant services; MD Analytics, Creative Research Designs, CTC Communications, Corporation, Alexion Pharmaceuticals, Figure 1, Rhodes Scholarships, MyMedicalPanel, and DeepBench; and stock holdings in Collavidence, Inc, and SnapDx, Inc. Dr Ganesh is a Review Editor of Stroke for Frontiers in Neurology and an Editorial Board Member of Stroke of the American Heart Association and Neurology and Neurology: Clinical Practice of American Academy of Neurology and reports travel supports from the American Heart Association, the American Academy of Neurology, and the University of Calgary. The other authors report no conflicts.