{
  "abstract": "Background and purpose Collateral blood flow to the affected cerebral territory in acute ischemic stroke may modify the effect of intravenous alteplase treatment (IVT) prior to endovascular treatment (EVT). We assessed whether an interaction effect between arterial collateral status, assessed by both a visual and quantitative collateral score (CS), and administration of IVT plus EVT was present in the MR CLEAN-NO IV trial.Methods Baseline CT or MR angiography (CTA and MRA) from patients included in MR CLEAN-NO IV was assessed using both a visual and automated quantitative score for arterial collateral status. We included 526 patients with visual CS and 401 with quantitative CS in this prespecified analysis. The primary outcome was functional outcome measured as the modified Rankin Scale score at 90 days. Interaction terms of treatment allocation (IVT plus EVT vs EVT alone) and collateral scores were included in regression models to assess whether the treatment effect of IVT differed by arterial collateral status.Results IVT plus EVT was not statistically significantly associated with better functional outcome compared with EVT alone (adjusted common odds ratio 1.14; 95% CI 0.84 to 1.55). There was no statistically significant modification of IVT treatment effect on functional outcome by either visual or quantitative CS (adjusted p-interaction=0.34; adjusted p-interaction=0.57, respectively).Conclusion In the MR CLEAN-NO IV trial, we did not find evidence that arterial collateral status measured with a visual score or quantitative score can inform treatment decisions regarding IVT plus EVT for patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation within 4.5 hours.",
  "authors": [
    {
      "affiliations": [
        "Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China",
        "Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Wenjin Yang"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Fabiano Cavalcante"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands",
        "Department of Radiology, Haaglanden MC, The Hague, The Netherlands"
      ],
      "name": "Kilian M. Treurniet"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Manon Kappelhof"
    },
    {
      "affiliations": [
        "Department of Radiation Oncology (Maastro), Maastricht University Medical Centre+, Maastricht, The Netherlands"
      ],
      "name": "Agnetha A.E. Bruggeman"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands"
      ],
      "name": "Lennard Wolff"
    },
    {
      "affiliations": [
        "Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Leon A. Rinkel"
    },
    {
      "affiliations": [
        "Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Natalie E. LeCouffe"
    },
    {
      "affiliations": [
        "NICO.LAB B.V, Amsterdam, The Netherlands"
      ],
      "name": "Ivo G.H. Jansen"
    },
    {
      "affiliations": [
        "NICO.LAB B.V, Amsterdam, The Netherlands"
      ],
      "name": "Aashish Venkatesh"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands",
        "Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands"
      ],
      "name": "Olvert A. Berkhemer"
    },
    {
      "affiliations": [
        "Department of Radiology, Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands"
      ],
      "name": "Anouk van der Hoorn"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Marieke E. Sprengers"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Bart J. Emmer"
    },
    {
      "affiliations": [
        "Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Jonathan M. Coutinho"
    },
    {
      "affiliations": [
        "Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Yvo B.W.E.M. Roos"
    },
    {
      "affiliations": [
        "Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands"
      ],
      "name": "Wim van Zwam"
    },
    {
      "affiliations": [
        "Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands"
      ],
      "name": "Robert van Oostenbrugge"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands",
        "Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Henk A. Marquering"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Charles B.L.M. Majoie"
    },
    {
      "affiliations": [],
      "name": "on behalf of the MR CLEAN-NO IV Investigators"
    }
  ],
  "title": "Arterial collateral status and treatment effect of intravenous alteplase thrombolysis prior to endovascular treatment in patients with anterior circulation large vessel occlusion: prespecified analysis of the MR CLEAN-NO IV trial",
  "uid": "f77f2937-3e91-5e5e-b404-fb5417b62e19"
}