Association of Estimated Arterial Stiffness with Collateral Status and Functional Outcome after Endovascular Thrombectomy: A Secondary Analysis of the OPTIMAL-BP Trial
Abstract
PURPOSE: Estimated pulse wave velocity (ePWV) is a surrogate of arterial stiffness that may influence stroke outcomes and potentially affect collateral circulation. We examined the association of ePWV with collateral status and 3-month functional outcome after successful endovascular thrombectomy and explored the contribution of collateral status to this relationship across blood pressure (BP) management strategies. MATERIALS AND METHODS: In this secondary analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control trial, 285 patients were analyzed. Collateral status was assessed using the Tan scale (poor, 0-1; good, 2-3). Poor functional outcome was defined as 3-month modified Rankin Scale score of 3-6. Multivariable logistic and mediation analyses were performed to evaluate the association between ePWV and functional outcomes and to explore direct and indirect pathways. RESULTS: A total of 285 patients were included (mean age, 73.3±11.3 years; 40.4% women). Each 1 m/s increase in ePWV was associated with poor collaterals (adjusted odds ratio [OR] 1.276, 95% confidence interval [CI] 1.083-1.503) and poor functional outcome (adjusted OR 1.338, 95% CI 1.121-1.597). In mediation analyses, collateral status accounted for only a small proportion of the association between ePWV and poor functional outcome (indirect effect: adjusted β 0.022, 95% CI 0.001-0.053), whereas the direct effect remained significant (adjusted β 0.237, 95% CI 0.115-0.359). Neither the direct effect of ePWV on functional outcome nor the indirect effect through collateral status differed according to BP management strategy. CONCLUSION: Higher ePWV was associated with poor collateral status and unfavorable functional outcome after successful reperfusion. Collateral status accounted for only a small proportion of the observed association between ePWV and functional outcome.
// Source
Authors: Minho Han, Eunjeong Park, Jae Wook Jung, Hyungwoo Lee, JoonNyung Heo, Young Dae Kim, Haram Joo, Kwang Hyun Kim, Jaeseob Yun, Joung-Woo Choi, Il Hyung Lee, Byung Moon Kim, Dong Joon Kim, Na‐Young Shin, Bang‐Hoon Cho, Seong Hwan Ahn, Hyungjong Park, Sung‐Il Sohn, Jeong‐Ho Hong, Tae‐Jin Song, Yoonkyung Chang, Gyu Sik Kim, Kwon–Duk Seo, Kijeong Lee, Jun Young Chang, Jung Hwa Seo, Sukyoon Lee, Jang‐Hyun Baek, Han‐Jin Cho, Dong Hoon Shin, Jae‐Joong Kim, Joonsang Yoo, Minyoul Baik, Yo Han Jung, Yang‐Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Chan Joo Lee, Sungha Park, Soyoung Jeon, Hye Sun Lee, Sun Uck Kwon, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam, the OPTIMAL-BP trial investigators
Institutions: Ewha Womans University, Yonsei University, Inje University Busan Paik Hospital, Yonsei University Health System, Samsung Medical Center, Gachon University Gil Medical Center, University of Ulsan, Asan Medical Center, Ewha Womans University Mokdong Hospital, Keimyung University, Kyungpook National University, Sungkyunkwan University, Pusan National University, Kangbuk Samsung Hospital, Severance Hospital, Gangnam Severance Hospital, Keimyung University Dongsan Hospital, Chosun University, Kyung Hee University Hospital at Gangdong, CHA University Bundang Medical Center, CHA University, Kyungpook National University Hospital, Dong-A University, Dong-A University Hospital, Ewha Womans University Seoul Hospital, Seoul Medical Center, Kyungpook National University Chilgok Hospital, National Health Insurance Service Ilsan Hospital, Chosun University Hospital, Korea University Anam Hospital, Korea University Guro Hospital, Keimyung University Daegu Dongsan Hospital, Daejeon Eulji Medical Center, Eulji University, Yongin Severance Hospital