The DOI matches its Crossref record; 20 of the 20 references it cites were found in a registry or an index.
Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke
Open accessAbstract
Background and Purpose—: Recent randomized trials have proven the benefit of intra-arterial treatment (IAT) with retrievable stents in acute ischemic stroke. Patients with poor or absent collaterals (preexistent anastomoses to maintain blood flow in case of a primary vessel occlusion) may gain less clinical benefit from IAT. In this post hoc analysis, we aimed to assess whether the effect of IAT was modified by collateral status on baseline computed tomographic angiography in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN). Methods—: MR CLEAN was a multicenter, randomized trial of IAT versus no IAT. Primary outcome was the modified Rankin Scale at 90 days. The primary effect parameter was the adjusted common odds ratio for a shift in direction of a better outcome on the modified Rankin Scale. Collaterals were graded from 0 (absent) to 3 (good). We used multivariable ordinal logistic regression analysis with interaction terms to estimate treatment effect modification by collateral status. Results—: We found a significant modification of treatment effect by collaterals ( P =0.038). The strongest benefit (adjusted common odds ratio 3.2 [95% confidence intervals 1.7–6.2]) was found in patients with good collaterals (grade 3). The adjusted common odds ratio was 1.6 [95% confidence intervals 1.0–2.7] for moderate collaterals (grade 2), 1.2 [95% confidence intervals 0.7–2.3] for poor collaterals (grade 1), and 1.0 [95% confidence intervals 0.1–8.7] for patients with absent collaterals (grade 0). Conclusions—: In MR CLEAN, baseline computed tomographic angiography collateral status modified the treatment effect. The benefit of IAT was greatest in patients with good collaterals on baseline computed tomographic angiography. Treatment benefit appeared less and may be absent in patients with absent or poor collaterals. Clinical Trial Registration—: URL: http://www.trialregister.nl and http://www.controlled-trials.com . Unique identifier: (NTR)1804 and ISRCTN10888758, respectively.
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Cites
A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke
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Self-citationInterobserver agreement for the assessment of handicap in stroke patients
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Self-citationRandomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke
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Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke
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Cited by
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Metadata
- Authors
- Berkhemer, O. A., Jansen, I. G. H., Beumer, D., Fransen, P. S. S., van den Berg, L. A., Yoo, A. J., Lingsma, H. F., Sprengers, M. E. S., Jenniskens, S. F. M., Lycklama à Nijeholt, G. J., van Walderveen, M. A. A., van den Berg, R., Bot, J. C. J., Beenen, L. F. M., Boers, A. M. M., Slump, C. H., Roos, Y. B. W. E. M., van Oostenbrugge, R. J., Dippel, D. W. J., van der Lugt, A., van Zwam, W. H., Marquering, H. A., Majoie, C. B. L. M., Schonewille, W. J., Vos, J.-A., Nederkoorn, P. J., Wermer, M. J. H., Staals, J., Hofmeijer, J., van Oostayen, J. A., Boiten, J., Brouwer, P. A., Emmer, B. J., de Bruijn, S. F., van Dijk, L. C., Kappelle, L. J., Lo, R. H., van Dijk, E. J., de Vries, J., de Kort, P. L. M., van den Berg, J. S. P., van Hassel, B. A. A. M., Aerden, L. A. M., Dallinga, R. J., Visser, M. C., Vroomen, P. C., Eshghi, O., Schreuder, T. H. C. M. L., Heijboer, R. J. J., Keizer, K., Tielbeek, A. V., den Hertog, H. M., Gerrits, D. G., van den Berg-Vos, R. M., Karas, G. B., Koudstaal, P. J., Flach, H. Z., Steyerberg, E. W., Brown, M. M., Liebig, T., & Stijnen, T.
- Venue
- Stroke
- Published
- 2016-03
- Volume
- 47
- Issue
- 3
- Pages
- 768-776
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2287126882
- Cited by
- 285
- References
- 20
- FWCI
- 23.71
- Type
- journal article
- Language
- en
- Open access
- bronze
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- Berkhemer, O. A., Jansen, I. G. H., Beumer, D., Fransen, P. S. S., van den Berg, L. A., Yoo, A. J., Lingsma, H. F., Sprengers, M. E. S., Jenniskens, S. F. M., Lycklama à Nijeholt, G. J., van Walderveen, M. A. A., van den Berg, R., Bot, J. C. J., Beenen, L. F. M., Boers, A. M. M., Slump, C. H., Roos, Y. B. W. E. M., van Oostenbrugge, R. J., Dippel, D. W. J., . . . Stijnen, T. (2016). Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke. Stroke. https://doi.org/10.1161/strokeaha.115.011788
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