基线计算机断层血管造影侧支循环对参与卒中干预管理III期试验患者临床结局的差异影响。
Differential Effect of Baseline Computed Tomographic Angiography Collaterals on Clinical Outcome in Patients Enrolled in the Interventional Management of Stroke III Trial.
作者信息
Menon Bijoy K, Qazi Emmad, Nambiar Vivek, Foster Lydia D, Yeatts Sharon D, Liebeskind David, Jovin Tudor G, Goyal Mayank, Hill Michael D, Tomsick Thomas A, Broderick Joseph P, Demchuk Andrew M
机构信息
From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.).
出版信息
Stroke. 2015 May;46(5):1239-44. doi: 10.1161/STROKEAHA.115.009009. Epub 2015 Mar 19.
BACKGROUND AND PURPOSE
In the Interventional Management of Stroke (IMS) III trial, we sought to demonstrate evidence of a differential treatment effect of endovascular treatment of acute ischemic stroke compared with intravenous tissue-type plasminogen activator, according to baseline collateral status measured using computed tomographic angiography.
METHODS
Of 656 patients enrolled in Interventional Management of Stroke III trial, 306 had baseline computed tomographic angiography. Of these, 185 patients had M1 middle cerebral artery ± intracranial internal carotid artery occlusion, where baseline collateral status could be measured. Collateral status was assessed by consensus using 3 different ordinal scales and categorized as good, intermediate, and poor. Multivariable modeling was used to assess the effect of collateral status and treatment type on clinical outcome by modified Rankin Scale (mRS 0-2, mRS 0-1, and the ordinal mRS).
RESULTS
Of 185 patients, 126 randomized to endovascular therapy (87.6% recanalized, 41.3% 90-day mRS 0-2) and 59 to intravenous tissue-type plasminogen activator only (60.5% recanalized, 30.5% 90-day mRS 0-2). In multivariable modeling, collateral status was a significant predictor of all clinical outcomes (P<0.05). Maximal benefit with endovascular treatment across all clinical outcomes was seen in patients with intermediate collaterals, some benefit in patients with good collaterals, and none in patients with poor collaterals, although small sample size limited the power of the analysis to show a statistically significant interaction between collateral status and treatment type (P>0.05).
CONCLUSION
Using data from a large randomized controlled trial (IMS III), we show that baseline computed tomographic angiography collaterals are a robust determinant of final clinical outcome and could be used to select patients for endovascular therapy.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov/ct2/show/. Unique identifier: 0020NCT00359424.
背景与目的
在卒中的介入治疗（IMS）III试验中，我们试图根据使用计算机断层血管造影测量的基线侧支循环状态，证明急性缺血性卒中血管内治疗与静脉注射组织型纤溶酶原激活剂相比具有不同治疗效果的证据。
方法
在纳入卒中介入治疗III试验的656例患者中，306例进行了基线计算机断层血管造影。其中，185例患者存在大脑中动脉M1段±颅内颈内动脉闭塞，可测量基线侧支循环状态。通过共识使用3种不同的有序量表评估侧支循环状态，并分为良好、中等和差。采用多变量建模，通过改良Rankin量表（mRS 0 - 2、mRS 0 - 1和有序mRS）评估侧支循环状态和治疗类型对临床结局的影响。
结果
185例患者中，126例随机接受血管内治疗（87.6%再通，41.3% 90天mRS 0 - 2），59例仅接受静脉注射组织型纤溶酶原激活剂（60.5%再通，30.5% 90天mRS 0 - 2）。在多变量建模中，侧支循环状态是所有临床结局的显著预测因素（P<0.05）。中等侧支循环的患者接受血管内治疗在所有临床结局中获益最大，良好侧支循环的患者有一定获益，差侧支循环的患者无获益，尽管样本量小限制了分析显示侧支循环状态与治疗类型之间存在统计学显著相互作用的能力（P>0.05）。
结论
利用一项大型随机对照试验（IMS III）的数据，我们表明基线计算机断层血管造影侧支循环是最终临床结局的有力决定因素，可用于选择血管内治疗的患者。
临床试验注册
网址：http://www.clinicaltrials.gov/ct2/show/。唯一标识符：0020NCT00359424。
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