Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness
Kappelhof, Manon (Amsterdam Universitair Medische Centra (Amsterdam, Països Baixos))
Tolhuisen, Manon L. (Biomedical Engineering and Physics)
Treurniet, Kilian M. (Radiology and Nuclear Medicine)
Dutra, Bruna G. (Biomedical Engineering and Physics)
Alves, Heitor (Biomedical Engineering and Physics)
Zhang, Guang (Radiology and Nuclear Medicine)
Brown, Scott (Altair Biostatistics)
Muir, Keith W. (Queen Elizabeth University Hospital)
Dávalos, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Roos, Yvo B. W. E. M. (University of Amsterdam)
Saver, Jeffrey L.. (University of California)
Demchuk, Andrew (University of Calgary)
Jovin, Tudor G. (University of Pittsburgh Medical Center)
Bracard, Serge (University of Lorraine)
Campbell, Bruce C.V (Royal Melbourne Hospital (Melbourne, Austràlia))
van der Lugt, Aad (Erasmus Medical Center)
Guillemin, Francis (University Hospital of Nancy)
White, Philip (Institute of Neuroscience)
Hill, M. D (University of Calgary)
Dippel, Diederik W. J. (Erasmus Medical Center)
Mitchell, Peter J. (Royal Melbourne Hospital (Melbourne, Austràlia))
Goyal, Mayank (University of Calgary)
Marquering, Henk A. (Biomedical Engineering and Physics)
Majoie, Charles B. L. M. (Radiology and Nuclear Medicine)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	Supplemental Digital Content is available in the text. Thrombus perviousness estimates residual flow along a thrombus in acute ischemic stroke, based on radiological images, and may influence the benefit of endovascular treatment for acute ischemic stroke. We aimed to investigate potential endovascular treatment (EVT) effect modification by thrombus perviousness. We included 443 patients with thin-slice imaging available, out of 1766 patients from the pooled HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials) data set of 7 randomized trials on EVT in the early window (most within 8 hours). Control arm patients (n=233) received intravenous alteplase if eligible (212/233; 91%). Intervention arm patients (n=210) received additional EVT (prior alteplase in 178/210; 85%). Perviousness was quantified by thrombus attenuation increase on admission computed tomography angiography compared with noncontrast computed tomography. Multivariable regression analyses were performed including multiplicative interaction terms between thrombus attenuation increase and treatment allocation. In case of significant interaction, subgroup analyses by treatment arm were performed. Our primary outcome was 90-day functional outcome (modified Rankin Scale score), resulting in an adjusted common odds ratio for a one-step shift towards improved outcome. Secondary outcomes were mortality, successful reperfusion (extended Thrombolysis in Cerebral Infarction score, 2B-3), and follow-up infarct volume (in mL). Increased perviousness was associated with improved functional outcome. After adding a multiplicative term of thrombus attenuation increase and treatment allocation, model fit improved significantly (P =0. 03), indicating interaction between perviousness and EVT benefit. Control arm patients showed significantly better outcomes with increased perviousness (adjusted common odds ratio, 1. 2 [95% CI, 1. 1-1. 3]). In the EVT arm, no significant association was found (adjusted common odds ratio, 1. 0 [95% CI, 0. 9-1. 1]), and perviousness was not significantly associated with successful reperfusion. Follow-up infarct volume (12% [95% CI, 7. 0-17] per 5 Hounsfield units) and chance of mortality (adjusted odds ratio, 0. 83 [95% CI, 0. 70-0. 97]) decreased with higher thrombus attenuation increase in the overall population, without significant treatment interaction. Our study suggests that the benefit of best medical care including alteplase, compared with additional EVT, increases in patients with more pervious thrombi.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cerebral infarction ; Decision making ; Reperfusion ; Stroke ; Thrombectomy ; Tissue-type plasminogen activator
Publicat a:	Stroke, Vol. 52 (july 2021) , p. 3633-3641, ISSN 1524-4628

DOI: 10.1161/STROKEAHA.120.033124
PMID: 34281377

9 p, 841.9 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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