Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial

BACKGROUND: Brain atrophy is suggested to impair the potential for functional recovery after acute ischemic stroke. We assessed whether the effect of endovascular treatment is modified by brain atrophy in patients with acute ischemic stroke due to large vessel occlusion. METHODS: We used data from M...

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Autores principales: Luijten, Sven PR, Compagne, Kars CJ, van Es, Adriaan CGM, Roos, Yvo BWEM, Majoie, Charles BLM, van Oostenbrugge, Robert J, van Zwam, Wim H, Dippel, Diederik WJ, Wolters, Frank J, van der Lugt, Aad, Bos, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9483187/
https://www.ncbi.nlm.nih.gov/pubmed/34711105
http://dx.doi.org/10.1177/17474930211054964
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author Luijten, Sven PR
Compagne, Kars CJ
van Es, Adriaan CGM
Roos, Yvo BWEM
Majoie, Charles BLM
van Oostenbrugge, Robert J
van Zwam, Wim H
Dippel, Diederik WJ
Wolters, Frank J
van der Lugt, Aad
Bos, Daniel
author_facet Luijten, Sven PR
Compagne, Kars CJ
van Es, Adriaan CGM
Roos, Yvo BWEM
Majoie, Charles BLM
van Oostenbrugge, Robert J
van Zwam, Wim H
Dippel, Diederik WJ
Wolters, Frank J
van der Lugt, Aad
Bos, Daniel
author_sort Luijten, Sven PR
collection PubMed
description BACKGROUND: Brain atrophy is suggested to impair the potential for functional recovery after acute ischemic stroke. We assessed whether the effect of endovascular treatment is modified by brain atrophy in patients with acute ischemic stroke due to large vessel occlusion. METHODS: We used data from MR CLEAN, a multicenter trial including patients with acute ischemic stroke due to anterior circulation large vessel occlusion randomized to endovascular treatment plus medical care (intervention) versus medical care alone (control). We segmented total brain volume (TBV) and intracranial volume (ICV) on baseline non-contrast computed tomography (n = 410). Next, we determined the degree of atrophy as the proportion of brain volume in relation to head size (1 − TBV/ICV) × 100%, analyzed as continuous variable and in tertiles. The primary outcome was a shift towards better functional outcome on the modified Rankin Scale expressed as adjusted common odds ratio. Treatment effect modification was tested using an interaction term between brain atrophy (as continuous variable) and treatment allocation. RESULTS: We found that brain atrophy significantly modified the effect of endovascular treatment on functional outcome (P for interaction = 0.04). Endovascular treatment led to larger shifts towards better functional outcome in the higher compared to the lower range of atrophy (adjusted common odds ratio, 1.86 [95% CI: 0.97–3.56] in the lowest tertile vs. 1.97 [95% CI: 1.03–3.74] in the middle tertile vs. 3.15 [95% CI: 1.59–6.24] in the highest tertile). CONCLUSION: Benefit of endovascular treatment is larger in the higher compared to the lower range of atrophy, demonstrating that advanced atrophy should not be used as an argument to withhold endovascular treatment.
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spelling pubmed-94831872022-09-20 Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial Luijten, Sven PR Compagne, Kars CJ van Es, Adriaan CGM Roos, Yvo BWEM Majoie, Charles BLM van Oostenbrugge, Robert J van Zwam, Wim H Dippel, Diederik WJ Wolters, Frank J van der Lugt, Aad Bos, Daniel Int J Stroke Research BACKGROUND: Brain atrophy is suggested to impair the potential for functional recovery after acute ischemic stroke. We assessed whether the effect of endovascular treatment is modified by brain atrophy in patients with acute ischemic stroke due to large vessel occlusion. METHODS: We used data from MR CLEAN, a multicenter trial including patients with acute ischemic stroke due to anterior circulation large vessel occlusion randomized to endovascular treatment plus medical care (intervention) versus medical care alone (control). We segmented total brain volume (TBV) and intracranial volume (ICV) on baseline non-contrast computed tomography (n = 410). Next, we determined the degree of atrophy as the proportion of brain volume in relation to head size (1 − TBV/ICV) × 100%, analyzed as continuous variable and in tertiles. The primary outcome was a shift towards better functional outcome on the modified Rankin Scale expressed as adjusted common odds ratio. Treatment effect modification was tested using an interaction term between brain atrophy (as continuous variable) and treatment allocation. RESULTS: We found that brain atrophy significantly modified the effect of endovascular treatment on functional outcome (P for interaction = 0.04). Endovascular treatment led to larger shifts towards better functional outcome in the higher compared to the lower range of atrophy (adjusted common odds ratio, 1.86 [95% CI: 0.97–3.56] in the lowest tertile vs. 1.97 [95% CI: 1.03–3.74] in the middle tertile vs. 3.15 [95% CI: 1.59–6.24] in the highest tertile). CONCLUSION: Benefit of endovascular treatment is larger in the higher compared to the lower range of atrophy, demonstrating that advanced atrophy should not be used as an argument to withhold endovascular treatment. SAGE Publications 2021-10-28 2022-10 /pmc/articles/PMC9483187/ /pubmed/34711105 http://dx.doi.org/10.1177/17474930211054964 Text en © 2021 World Stroke Organization https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Research
Luijten, Sven PR
Compagne, Kars CJ
van Es, Adriaan CGM
Roos, Yvo BWEM
Majoie, Charles BLM
van Oostenbrugge, Robert J
van Zwam, Wim H
Dippel, Diederik WJ
Wolters, Frank J
van der Lugt, Aad
Bos, Daniel
Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial
title Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial
title_full Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial
title_fullStr Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial
title_full_unstemmed Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial
title_short Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial
title_sort brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the mr clean trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9483187/
https://www.ncbi.nlm.nih.gov/pubmed/34711105
http://dx.doi.org/10.1177/17474930211054964
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