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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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SAGE Publications
2021
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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. |
format | Online Article Text |
id | pubmed-9483187 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
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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