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000277314 0247_ $$2doi$$a10.1148/radiol.242401
000277314 0247_ $$2pmid$$apmid:39998372
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000277314 0247_ $$2ISSN$$a1527-1315
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000277314 037__ $$aDZNE-2025-00377
000277314 041__ $$aEnglish
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000277314 1001_ $$00000-0002-9103-5983$$aWinkelmeier, Laurens$$b0
000277314 245__ $$aArterial Collaterals and Endovascular Treatment Effect in Acute Ischemic Stroke with Large Infarct: A Secondary Analysis of the TENSION Trial.
000277314 260__ $$aOak Brook, Ill.$$bSoc.$$c2025
000277314 3367_ $$2DRIVER$$aarticle
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000277314 3367_ $$00$$2EndNote$$aJournal Article
000277314 520__ $$aBackground Randomized clinical trials have demonstrated that endovascular thrombectomy reduces functional disability in patients with large ischemic stroke; arterial collateral status might be used to select these patients for endovascular thrombectomy. Purpose To investigate whether arterial collateral status modifies the treatment effect of endovascular thrombectomy in patients with large ischemic stroke. Materials and Methods The Efficacy and Safety of Thrombectomy in Stroke with Extended Lesion and Extended Time Window (TENSION) trial was a prospective, multicenter, randomized study investigating participants with acute large ischemic stroke due to anterior circulation large-vessel occlusion. Participants with an Alberta Stroke Program Early CT Score of 3-5 were enrolled at 41 participating centers between July 2018 and February 2023. Participants were randomly assigned to undergo either endovascular thrombectomy with best medical treatment or best medical treatment alone within 12 hours from stroke onset. Collateral status was graded on pretreatment single-phase CT angiography (CTA) images using the Tan score and dichotomized into poor (grade, 0-1) or good (grade, 2-3) based on the extent of collateral supply filling the affected middle cerebral artery territory. The primary outcome was the shift on the 90-day modified Rankin Scale (mRS). Results Of 253 randomized patients, 201 with pretreatment CTA were included (median age, 74 years; IQR, 66-80 years; 103 [51.2%] female patients; 103 [51.2%] patients underwent endovascular thrombectomy). Endovascular thrombectomy compared with best medical treatment (adjusted common odds ratio [OR], 3.69; 95% CI: 2.12, 6.54; P < .001) and good collaterals compared with poor collaterals (adjusted common OR, 2.88; 95% CI: 1.63, 5.11; P < .001) were independently associated with a shift in the 90-day mRS scores toward better functional outcomes. The treatment effect of endovascular thrombectomy over best medical treatment was not modified by collateral status (interaction, P = .88). The treatment effect of endovascular thrombectomy versus best medical treatment was found in patients with good collaterals (adjusted common OR, 3.93; 95% CI: 1.65, 9.69; P = .002) and poor collaterals (adjusted common OR, 3.92; 95% CI: 1.86, 8.52; P < .001). Conclusion In this secondary analysis of data from the TENSION trial, endovascular thrombectomy reduced 90-day functional disability compared with best medical treatment in patients with good and poor collaterals. These findings suggest that patients with large ischemic stroke manifesting within 12 hours after onset should undergo endovascular thrombectomy irrespective of single-phase CTA collateral status. ClinicalTrials.gov Identifier: NCT03094715 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Benomar and Raymond in this issue.
000277314 536__ $$0G:(DE-HGF)POF4-353$$a353 - Clinical and Health Care Research (POF4-353)$$cPOF4-353$$fPOF IV$$x0
000277314 588__ $$aDataset connected to CrossRef, PubMed, , Journals: pub.dzne.de
000277314 650_2 $$2MeSH$$aHumans
000277314 650_2 $$2MeSH$$aFemale
000277314 650_2 $$2MeSH$$aMale
000277314 650_2 $$2MeSH$$aEndovascular Procedures: methods
000277314 650_2 $$2MeSH$$aIschemic Stroke: diagnostic imaging
000277314 650_2 $$2MeSH$$aIschemic Stroke: surgery
000277314 650_2 $$2MeSH$$aIschemic Stroke: therapy
000277314 650_2 $$2MeSH$$aAged
000277314 650_2 $$2MeSH$$aThrombectomy: methods
000277314 650_2 $$2MeSH$$aCollateral Circulation
000277314 650_2 $$2MeSH$$aProspective Studies
000277314 650_2 $$2MeSH$$aComputed Tomography Angiography: methods
000277314 650_2 $$2MeSH$$aTreatment Outcome
000277314 650_2 $$2MeSH$$aMiddle Aged
000277314 650_2 $$2MeSH$$aAged, 80 and over
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