Rofo 2025; 197(S 01): S49-S50
DOI: 10.1055/s-0045-1802810
Abstracts
Vortrag (Wissenschaft)
Neuroradiologie

Arterial Collateral Status and Drip-and-Ship Transfer in Acute Ischemic Stroke with Large Infarct: A Post-hoc Analysis of the TENSION Trial

Authors

  • L Winkelmeier

    1   Universitätsklinikum Hamburg-Eppendorff, Klinik und Poliklinik für Neuroradiologische Diagnostik und, Hamburg

  • G Thomalla

    2   Universitätsklinikum Hamburg-Eppendorf, Neurologie, Hamburg

  • M Bendszus

    3   Universitätsklinikum Heidelberg, Neuroradiologie, Heidelberg

  • J Fiehler

    4   Universitätsklinikum Hamburg-Eppendorf, Neuroradiologie, Hamburg

  • F Flottmann

    4   Universitätsklinikum Hamburg-Eppendorf, Neuroradiologie, Hamburg
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    Zielsetzung Endovascular thrombectomy (EVT) is efficacious in reducing functional disability in patients with acute ischemic stroke and large infarct. Many patients are initially admitted to a primary stroke center and then transferred to a comprehensive stroke center with thrombectomy capabilities (drip-and-ship). Data are scarce on whether arterial collateral status can be used to select patients with large ischemic stroke who do not benefit from EVT and in whom transfer is likely to be futile.

    Material und Methoden The TENSION trial was a prospective, multicenter, randomized study involving patients with acute ischemic stroke and large infarct. Patients with an Alberta Stroke Program Early CT Score (ASPECTS) of 3-5 were enrolled at 41 participating centers between 2018 and 2023. Patients were randomized to receive either EVT or medical treatment alone within 12 hours of stroke onset. Arterial collateral status was assessed on pretreatment single-phase CTA using the Tan score and subdivided into poor (grade 0-1) and good (grade 2-3) collaterals. Primary outcome was the shift on the 90-day modified Rankin Scale.

    Ergebnisse A total of 114 drip-and-ship patients with pretreatment CTA were included (median age, 74 [IQR, 66-80]; 53.5% female; 35.1% poor collaterals; 49.1% EVT). EVT compared to medical treatment (adjusted common odds ratio [acOR], 3.70, 95% confidence interval [CI], 1.76-8.00, P<.001) and good collaterals compared to poor collaterals (acOR, 3.41, 95% CI, 1.59-7.42) were associated with improved 90-day functional outcomes. The treatment effect of EVT over medical treatment was not modified by arterial collateral status (interaction, P=.42).

    Schlussfolgerungen In the TENSION trial, drip-and-ship patients with large ischemic stroke benefited from EVT, without significant modification of treatment effect by arterial collateral status. These findings suggest that arterial collateral status cannot reliably identify patients with large ischemic stroke for whom interhospital transfer for EVT would likely be futile.


     

    Publication History

    Article published online:
    25 March 2025

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