In:
Cerebrovascular Diseases, S. Karger AG, Vol. 47, No. 3-4 ( 2019), p. 171-177
Abstract:
〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Collateral circulation may modify the effect of neuroprotective therapies. We report a post hoc analysis of the URICO-ICTUS trial (NCT00860366) assessing the modifying treatment effect of pretreatment collaterals on clinical and radiological outcomes in patients with large-vessel acute ischemic stroke receiving uric acid therapy or placebo. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 URICO-ICTUS was a randomized clinical trial where 411 alteplase-treated patients also received uric acid 1,000 mg ( 〈 i 〉 n 〈 /i 〉 = 211) or placebo ( 〈 i 〉 n 〈 /i 〉 = 200) before the end of alteplase infusion. Herein, we included a nested study of 84 patients (placebo = 40, uric acid = 44) who had a pretreatment CT-angiography (CTA) showing a proximal arterial occlusion in the carotid territory. Excellent collaterals were defined as 100% collateral supply on pretreatment CTA. Regression models assessed the interaction between therapy (uric acid/placebo) and collaterals on the main outcome (ordinal modified Rankin Scale [mRS] shift at 90 days). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Overall, excellent collaterals were associated with improved outcome. There was a significant interaction between therapy and pretreatment collaterals ( 〈 i 〉 p 〈 /i 〉 interaction = 0.02) for the prediction of improved mRS shift. The largest treatment contrast in favor of uric acid was found in patients with excellent collaterals (adjusted OR 9.2; 95% CI 1.23–68.6; 〈 i 〉 p 〈 /i 〉 = 0.03). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Collectively, the study found that collaterals were associated with the neuroprotective effect of uric acid therapy highlighting the importance of assessing collateral status in neuroprotection trials.
Type of Medium:
Online Resource
ISSN:
1015-9770
,
1421-9786
Language:
English
Publisher:
S. Karger AG
Publication Date:
2019
detail.hit.zdb_id:
1482069-9
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