RT info:eu-repo/semantics/article
T1 Brain Atrophy and the Risk of Futile Endovascular Reperfusion in Acute Ischemic Stroke
A1 Pedraza, María I.
A1 de Lera, Mercedes
A1 Bos, Daniel
A1 Calleja, Ana I.
A1 Cortijo, Elisa
A1 Gómez-Vicente, Beatriz
A1 Reyes, Javier
A1 Coco Martín, María Begoña
A1 Calonge, Teodoro
A1 Agulla, Jesús
A1 Martínez-Pías, Enrique
A1 Talavera, Blanca
A1 Pérez-Fernández, Santiago
A1 Schüller, Miguel
A1 Galván, Jorge
A1 Castaño, Miguel
A1 Martínez-Galdámez Ruiz, Mario
A1 Arenillas Lara, Juan Francisco
AB BackgroundBrain 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.MethodsWe 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.ResultsWe 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).ConclusionBenefit 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.
PB AHA Journals
SN 0039-2499
YR 2020
FD 2020
LK https://uvadoc.uva.es/handle/10324/64438
UL https://uvadoc.uva.es/handle/10324/64438
LA spa
NO Stroke. 2020 May;51(5):1514-1521
DS UVaDOC
RD 24-nov-2024