Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).

BACKGROUND AND PURPOSE: Infarct in a new previously unaffected territory (INT) is a potential complication of endovascular treatment. We applied a recently proposed methodology to identify and classify INTs in the ESCAPE randomized controlled trial (Endovascular Treatment for Small Core and Anterior...

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Main Authors: Ganesh, A, Al-Ajlan, F, Sabiq, F, Assis, Z, Rempel, J, Butcher, K, Thornton, J, Kelly, P, Roy, D, Poppe, A, Jovin, T, Devlin, T, Baxter, B, Krings, T, Casaubon, L, Frei, D, Choe, H, Tampieri, D, Teitelbaum, J, Lum, C, Mandzia, J, Phillips, S, Bang, O, Almekhlafi, M, Coutts, S, Barber, P, Sajobi, T, Demchuk, A, Eesa, M, Hill, M, Goyal, M, Menon, B, ESCAPE Trial Investigators
Format: Journal article
Language:English
Published: American Heart Association 2016
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author Ganesh, A
Al-Ajlan, F
Sabiq, F
Assis, Z
Rempel, J
Butcher, K
Thornton, J
Kelly, P
Roy, D
Poppe, A
Jovin, T
Devlin, T
Baxter, B
Krings, T
Casaubon, L
Frei, D
Choe, H
Tampieri, D
Teitelbaum, J
Lum, C
Mandzia, J
Phillips, S
Bang, O
Almekhlafi, M
Coutts, S
Barber, P
Sajobi, T
Demchuk, A
Eesa, M
Hill, M
Goyal, M
Menon, B
ESCAPE Trial Investigators
author_facet Ganesh, A
Al-Ajlan, F
Sabiq, F
Assis, Z
Rempel, J
Butcher, K
Thornton, J
Kelly, P
Roy, D
Poppe, A
Jovin, T
Devlin, T
Baxter, B
Krings, T
Casaubon, L
Frei, D
Choe, H
Tampieri, D
Teitelbaum, J
Lum, C
Mandzia, J
Phillips, S
Bang, O
Almekhlafi, M
Coutts, S
Barber, P
Sajobi, T
Demchuk, A
Eesa, M
Hill, M
Goyal, M
Menon, B
ESCAPE Trial Investigators
author_sort Ganesh, A
collection OXFORD
description BACKGROUND AND PURPOSE: Infarct in a new previously unaffected territory (INT) is a potential complication of endovascular treatment. We applied a recently proposed methodology to identify and classify INTs in the ESCAPE randomized controlled trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). <br/>METHODS: The core laboratory identified INTs on 24-hour follow-up imaging, blinded to treatment allocation, after assessing all baseline imaging. INTs were classified into 3 types (I-III) and 2 subtypes (A/B) based on size and if catheter manipulation was likely performed across the vessel territory ostium. Logistic regression was used to understand the effect of multiple a priori identified variables on INT occurrence. Ordinal logistic regression was used to analyze the effect of INTs on modified Rankin Scale shift at 90 days. <br/>RESULTS: From 308 patients included, 14 INTs (4.5% overall; 2.8% on follow-up noncontrast computed tomography, 11.7% on follow-up magnetic resonance imaging) were identified (5.0% in endovascular treatment arm versus 4.0% in control arm [P=0.7]). The use of intravenous alteplase was associated with a 68% reduction in the odds of INT occurrence (3.0% with versus 9.1% without; odds ratio, 0.32; 95% confidence interval, 0.11-0.96; adjusted for age, sex, and treatment type). No other variables were associated with INTs. INT occurrence was associated with reduced probability of good clinical outcome (common odds ratio, 0.25; 95% confidence interval, 0.09-0.74; adjusted for age, type of treatment, and follow-up scan). <br/>CONCLUSIONS: INTs are uncommon, detected more frequently on follow-up magnetic resonance imaging, and affect clinical outcome. In experienced centers, endovascular treatment is likely not causal, whereas intravenous alteplase may be therapeutic. <br/>CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335.
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spelling oxford-uuid:154127a4-1571-4db6-a334-52e6892c13b02022-03-26T10:24:29ZInfarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:154127a4-1571-4db6-a334-52e6892c13b0EnglishSymplectic Elements at OxfordAmerican Heart Association2016Ganesh, AAl-Ajlan, FSabiq, FAssis, ZRempel, JButcher, KThornton, JKelly, PRoy, DPoppe, AJovin, TDevlin, TBaxter, BKrings, TCasaubon, LFrei, DChoe, HTampieri, DTeitelbaum, JLum, CMandzia, JPhillips, SBang, OAlmekhlafi, MCoutts, SBarber, PSajobi, TDemchuk, AEesa, MHill, MGoyal, MMenon, BESCAPE Trial InvestigatorsBACKGROUND AND PURPOSE: Infarct in a new previously unaffected territory (INT) is a potential complication of endovascular treatment. We applied a recently proposed methodology to identify and classify INTs in the ESCAPE randomized controlled trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). <br/>METHODS: The core laboratory identified INTs on 24-hour follow-up imaging, blinded to treatment allocation, after assessing all baseline imaging. INTs were classified into 3 types (I-III) and 2 subtypes (A/B) based on size and if catheter manipulation was likely performed across the vessel territory ostium. Logistic regression was used to understand the effect of multiple a priori identified variables on INT occurrence. Ordinal logistic regression was used to analyze the effect of INTs on modified Rankin Scale shift at 90 days. <br/>RESULTS: From 308 patients included, 14 INTs (4.5% overall; 2.8% on follow-up noncontrast computed tomography, 11.7% on follow-up magnetic resonance imaging) were identified (5.0% in endovascular treatment arm versus 4.0% in control arm [P=0.7]). The use of intravenous alteplase was associated with a 68% reduction in the odds of INT occurrence (3.0% with versus 9.1% without; odds ratio, 0.32; 95% confidence interval, 0.11-0.96; adjusted for age, sex, and treatment type). No other variables were associated with INTs. INT occurrence was associated with reduced probability of good clinical outcome (common odds ratio, 0.25; 95% confidence interval, 0.09-0.74; adjusted for age, type of treatment, and follow-up scan). <br/>CONCLUSIONS: INTs are uncommon, detected more frequently on follow-up magnetic resonance imaging, and affect clinical outcome. In experienced centers, endovascular treatment is likely not causal, whereas intravenous alteplase may be therapeutic. <br/>CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335.
spellingShingle Ganesh, A
Al-Ajlan, F
Sabiq, F
Assis, Z
Rempel, J
Butcher, K
Thornton, J
Kelly, P
Roy, D
Poppe, A
Jovin, T
Devlin, T
Baxter, B
Krings, T
Casaubon, L
Frei, D
Choe, H
Tampieri, D
Teitelbaum, J
Lum, C
Mandzia, J
Phillips, S
Bang, O
Almekhlafi, M
Coutts, S
Barber, P
Sajobi, T
Demchuk, A
Eesa, M
Hill, M
Goyal, M
Menon, B
ESCAPE Trial Investigators
Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).
title Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).
title_full Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).
title_fullStr Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).
title_full_unstemmed Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).
title_short Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).
title_sort infarct in a new territory after treatment administration in the escape randomized controlled trial endovascular treatment for small core and anterior circulation proximal occlusion with emphasis on minimizing ct to recanalization times
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