Combining Early Ischemic Change and Collateral Extent for Functional Outcomes After Endovascular Therapy: An Analysis From AcT Trial-Reference-Cited by-同舟云学术

Combining Early Ischemic Change and Collateral Extent for Functional Outcomes After Endovascular Therapy: An Analysis From AcT Trial

Published:2024-07 Issue:7 Volume:55 Page:1758-1766
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Tanaka Koji¹^ORCID,Kaveeta Chitapa¹²^ORCID,Pensato Umberto¹³⁴^ORCID,Zhang Jianhai¹^ORCID,Bala Fouzi⁵⁶^ORCID,Alhabli Ibrahim⁵^ORCID,Horn MacKenzie¹^ORCID,Ademola Ayoola¹⁷^ORCID,Almekhlafi Mohammed¹⁵⁸^ORCID,Ganesh Aravind¹⁵⁷⁸^ORCID,Buck Brian⁹^ORCID,Tkach Aleksander¹⁰^ORCID,Catanese Luciana¹¹^ORCID,Dowlatshahi Dar¹²^ORCID,Shankar Jai¹³^ORCID,Poppe Alexandre Y.¹⁴^ORCID,Shamy Michel¹²^ORCID,Qiu Wu¹⁵^ORCID,Swartz Richard H.¹⁶^ORCID,Hill Michael D.¹⁵⁷⁸¹⁷,Sajobi Tolulope T.¹⁷⁸^ORCID,Menon Bijoy K.¹⁵⁷⁸^ORCID,Demchuk Andrew M.¹⁸^ORCID,Singh Nishita¹¹⁸^ORCID

Affiliation:

1. 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.

2. Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (C.K.).

3. Department of Biomedical Sciences, Humanitas University, Milan, Italy (U.P.).

4. IRCCS Humanitas Research Hospital, Milan, Italy (U.P.).

5. 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.

6. Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, France (F.B.).

7. 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.

8. 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.

9. Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (B.B.).

10. Department of Neurosciences, Kelowna General Hospital, BC, Canada (A.T.).

11. Department of Medicine, McMaster University, Hamilton, ON, Canada (L.C.).

12. Department of Medicine and Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M.S.).

13. Department of Radiology, Health Sciences Center (J.S.), University of Manitoba, Winnipeg, Canada.

14. Department of Clinical Neurosciences, Université de Montréal, QC, Canada (A.Y.P.).

15. Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan, China (W.Q.).

16. Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (R.H.S.).

17. Department of Medicine (M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada.

18. Department of Internal Medicine, Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada.

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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