Impact of collaterals on successful revascularization in Solitaire FR with the intention for thrombectomy.
Impact of collaterals on successful revascularization in Solitaire FR with the intention for thrombectomy.
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DOI：
10.1161/strokeaha.114.004781
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发表时间：
2014-07
期刊：
影响因子：
8.3
通讯作者：
SWIFT Investigators
中科院分区：
文献类型：
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作者：
Liebeskind DS;Jahan R;Nogueira RG;Zaidat OO;Saver JL;SWIFT Investigators
在Solitaire FR血栓切除术（SWIFT）研究中，分析了血管内治疗前血管造影时的结肠收缩，以确定对成功血运重建的新终点（无症状性出血）的影响。基线血管造影的侧支循环分级（美国介入和治疗神经放射学会/介入放射学会）独立评估，对其他数据设盲，统计分析描述与临床、实验室和成像参数的关系。144例受试者中有119例获得了侧支血管造影数据（平均年龄：67±12岁; 52%为女性;美国国立卫生研究院卒中量表中位数：18 [范围：8-28]）。在基线血糖升高（P=0.013）和基线收缩压升高（P=0.039）的受试者中观察到更差的侧支循环。部分或更严重侧支循环的多变量预测因子包括既往无高血压（比值比，4.049，P=0.012）、吸烟史（比值比，3.822; P=0.013）和高血糖（比值比，1.017; P=0.022）。基线时，结肠炎与阿尔伯塔卒中项目早期CT评分（ASPECTS）密切相关（0-1：中位数8 [3-10]; 2-9 [5-10]; 3-9 [7-10]; 4-9 [8-10]; P<0.001）和24小时（0-1：中位数1 [0-5]; 2-6 [0-10]; 3-8 [0-10]; 4-8 [4-8]; P<0.001）。脑梗死2b/3再灌注溶栓组侧支循环较好（P=0.019），出院第7天美国国立卫生研究院卒中评分中位数较好（P<0.001），第90天改良兰金评分较好（P<0.001）。较好的侧支循环分级与成功血运重建相关，无症状性出血，平均值为2.3（95%置信区间，2.1-2.5）vs 1.9（95%置信区间，1.7-2.2），P=0.021。更好的侧支循环与更低的血糖、更低的血压、更小的SWIFT基线梗死、更大的成功血运重建而不出血的可能性和良好的临床结局相关。URL：http://www.clinicaltrials.gov。唯一标识符：NCT 01054560。
Collaterals at angiography before endovascular therapy were analyzed to ascertain the effect on a novel end point of successful revascularization without symptomatic hemorrhage in the Solitaire FR With the Intention for Thrombectomy (SWIFT) study. Collateral grade (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology) on baseline angiography was independently assessed, blind to other data, with statistical analyses delineating the relationship with clinical, laboratory, and imaging parameters. Angiographic data on collaterals were available in 119 of 144 subjects (mean age, 67±12 years; 52% woman; median National Institutes of Health Stroke Scale, 18 [range, 8–28]). Worse collaterals were noted in subjects with elevated baseline blood glucose (P=0.013) and those with elevated baseline systolic blood pressure (P=0.039). Multivariate predictors of partial or worse collaterals included absence of prior hypertension (odds ratio, 4.049, P=0.012), smoking history (odds ratio, 3.822; P=0.013), and higher blood glucose (odds ratio, 1.017; P=0.022). Collaterals were strongly related to Alberta Stroke Program Early CT Score (ASPECTS) at baseline (0–1: median 8 [3–10]; 2–9 [5–10]; 3–9 [7–10]; 4–9 [8–10]; P<0.001) and 24 hours (0–1: median 1 [0–5]; 2–6 [0–10]; 3–8 [0–10]; 4–8 [4–8]; P<0.001). Better collaterals were linked with Thrombolysis in Cerebral Infarction 2b/3 reperfusion (P=0.019), better median National Institutes of Health Stroke Scale at day 7/discharge (P<0.001), and better day 90 modified Rankin Scale (P<0.001). Better collateral grade was associated with successful revascularization without symptomatic hemorrhage, mean 2.3 (95% confidence interval, 2.1–2.5) versus 1.9 (95% confidence interval, 1.7–2.2), P=0.021. Better collaterals were associated with lower glucose, lower blood pressure, smaller baseline infarcts in SWIFT, and greater likelihood of successful revascularization without hemorrhage and good clinical outcomes. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01054560.