Open AccessBrain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial
Author(s) -
Sven P.R. Luijten,
Kars C.J. Compagne,
Adriaan Cgm van Es,
Yvo B.W.E.M. Roos,
Charles B.L.M. Majoie,
Robert J. van Oostenbrugge,
Wim H. van Zwam,
Diederik W.J. Dippel,
Frank J. Wolters,
Aad van der Lugt,
Daniël Bos
Publication year - 2021
Publication title -
international journal of stroke
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.375
H-Index - 74
eISSN - 1747-4949
pISSN - 1747-4930
DOI - 10.1177/17474930211054964
Subject(s) - medicine , atrophy , modified rankin scale , odds ratio , stroke (engine) , randomized controlled trial , cardiology , endovascular treatment , surgery , ischemia , ischemic stroke , aneurysm , mechanical engineering , engineering
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.