Abstract 7: Differential Effect of Baseline Cta Collateral Status on Clinical Outcomes in Patients Enrolled in the Ims-3 Trial
Introduction: In the IMS 3 trial, we test the hypothesis that a differential effect of endovascular therapy on clinical outcome will be most apparent in patients with severely ischemic but salvageable brain tissue (moderate collaterals on baseline CTA).
Methods: Data is from patients in the IMS 3 study. Of 656 patients in the study, 306 patients had baseline CTA and 204 patients had M1 MCA +/_ intracranial ICA occlusion where baseline collaterals could be measured. Collateral status was assessed by consensus using 3 different scores and categorized as good, intermediate and poor. Details of the IMS 3 study protocol are described in the primary paper.
Results: Of 204 patients, 138 received endovascular therapy (85.7% recanalized, 44.2% achieved 90-day mRS 0-2) and 66 received IV tPA only (57.1% recanalized, 36.4% achieved 90-day mRS 0-2). Proportion of patients with 90-day mRS 0-2 in good, intermediate and poor collateral categories between endovascular therapy and IV tPA across the 3 scores were: score 1(good: 56.5% vs. 41.7%, intermediate: 45.2% vs. 22.2%, poor: 18.4% vs. 23.5%); score 2 (good: 57.4% vs. 42.3%, intermediate: 40% vs. 23.1%, poor: 5.3% vs. 14.3%); score 3 (good: 51.6% vs. 42.3%, intermediate: 43.3% vs. 23.5%, poor: 20.6% vs. 18.8%). Using the van-Elteren test, a significant shift in 90-day mRS distribution in favor of endovascular therapy was noted only for subjects with intermediate collaterals. (p=0.01 for scores 1 and 2, Figure 1) Clinical outcome was poor with no differential effect of therapy in patients with poor collaterals.
Conclusion: Patients with baseline intermediate collaterals have the highest likelihood of showing better clinical response to endovascular therapy. Future clinical trials testing IV tPA vs. endovascular therapy may have a higher likelihood of showing differential treatment effect if patients with baseline poor collaterals are excluded.
Author Disclosures: B.K. Menon: Other Research Support; Modest; Faculty of Medicine, University of Calgary; Heart and Stroke Foundation of Canada. E. Qazi: None. V. Nambiar: None. L.D. Foster: None. S. Yeatts: Other; Significant; Research Grant – Significant – IMS III Co-investigator Consultant – Genentech: PRISMS Steering Committee Member. D. Liebeskind: None. T. Jovin: Other; Significant; consulting fees and stock options from Silk Road Medical. M.D. Hill: Other; Significant; Research grant, significant --> Covidien Ltd., Hoffmann-La Roche Canada Ltd. Consultant/Advisory Board, modest ---> Heart & Stroke Foundation of Alberta,NWT,NU. M. Goyal: Speakers' Bureau; Modest; Covidien EV3. Research Grant; Significant; Institutional grant for ESCAPE trial from Covidien EV3. Consultant/Advisory Board; Significant; Covidien EV3 for help with design and execution of SWIFT PRIME. T. Tomsick: Other; Significant; Research grant, significant Covidien Ltd.; Research grant, significant IMS III. J. Broderick: Other; Significant; Other Research Support; Significant; Genentech-study medication for NINDS-funded IMS III and CLEARER trials, Genentech -PRISMS Trial consultant on steering committee, Penumbra-THERAPY Trial co-inv (pa. A.M. Demchuk: Other; Significant; Research grant, significant Covidien Ltd..
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