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Tytuł:
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Discrepancy between post-treatment infarct volume and 90-day outcome in the ESCAPE randomized controlled trial.
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Autorzy:
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Ganesh A; Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Menon BK; Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.; Department of Radiology, University of Calgary, Calgary, Canada.; Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Canada.; Hotchkiss Brain Institute, Calgary, Canada.
Assis ZA; Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.; Department of Radiology, University of Calgary, Calgary, Canada.
Demchuk AM; Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.; Department of Radiology, University of Calgary, Calgary, Canada.; Hotchkiss Brain Institute, Calgary, Canada.
Al-Ajlan FS; Department of Neurosciences, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
Al-Mekhlafi MA; Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.; Department of Radiology, University of Calgary, Calgary, Canada.; Hotchkiss Brain Institute, Calgary, Canada.
Rempel JL; Department of Radiology, University of Alberta, Edmonton, Canada.
Shuaib A; Stroke Program and Department of Medicine, University of Alberta, Edmonton, Canada.
Baxter BW; Department of Radiology, University of Tennessee, Erlanger Hospital, Knoxville, TN, USA.
Devlin T; Department of Neurology, University of Tennessee, Erlanger Hospital, Knoxville, TN, USA.
Thornton J; Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin, Ireland.
Williams D; Department of Geriatric & Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Poppe AY; Department of Neurosciences, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Canada.
Roy D; Department of Radiology, CHUM, Université de Montréal, Montreal, Canada.
Krings T; Department of Medical Imaging, University Health Network, University of Toronto, Toronto Western Hospital, Toronto, Canada.
Casaubon LK; Division of Neurology, Stroke Program, University Health Network, University of Toronto, Toronto Western Hospital, Toronto, Canada.
Kashani N; Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.; Department of Radiology, University of Calgary, Calgary, Canada.
Hill MD; Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.; Department of Radiology, University of Calgary, Calgary, Canada.; Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Canada.; Hotchkiss Brain Institute, Calgary, Canada.
Goyal M; Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.; Department of Radiology, University of Calgary, Calgary, Canada.; Hotchkiss Brain Institute, Calgary, Canada.
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Źródło:
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International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2021 Jul; Vol. 16 (5), pp. 593-601. Date of Electronic Publication: 2020 Jun 09.
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Typ publikacji:
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Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 2016- : Thousand Oaks, CA : SAGE Publications
Original Publication: Oxford, UK : Blackwell Pub., c2005-
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MeSH Terms:
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Brain Ischemia*/complications
Brain Ischemia*/therapy
Stroke*/diagnostic imaging
Stroke*/therapy
Aged ; Humans ; Infarction ; Risk Factors ; Thrombectomy ; Treatment Outcome
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Contributed Indexing:
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Keywords: Cerebrovascular disease/stroke; endovascular treatment; functional outcome; infarct size; modified Rankin Scale; post-stroke complications
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Molecular Sequence:
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ClinicalTrials.gov NCT01778335
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Entry Date(s):
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Date Created: 20200610 Date Completed: 20211025 Latest Revision: 20211025
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Update Code:
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20240104
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DOI:
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10.1177/1747493020929943
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PMID:
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32515694
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Background: Some patients with ischemic stroke have poor outcomes despite small infarcts after endovascular thrombectomy, while others with large infarcts sometimes fare better.
Aims: We explored factors associated with such discrepancies between post-treatment infarct volume (PIV) and functional outcome.
Methods: We identified patients with small PIV (volume ≤ 25th percentile) and large PIV (volume ≥ 75th percentile) on 24-48-h CT/MRI in the ESCAPE randomized-controlled trial. Demographics, comorbidities, baseline, and 24-48-h stroke severity (NIHSS), stroke location, treatment type, post-stroke complications, and other outcome scales like Barthel Index, and EQ-5D were compared between "discrepant cases" - those with 90-day modified Rankin Scale(mRS) ≤ 2 despite large PIV or mRS ≥ 3 despite small PIV - and "non-discrepant cases". Multi-variable logistic regression was used to identify pre-treatment and post-treatment factors associated with small-PIV/mRS ≥ 3 and large-PIV/mRS ≤ 2. Sensitivity analyses used different definitions of small/large PIV and good/poor outcome.
Results: Among 315 patients, median PIV was 21 mL; 27/79 (34.2%) patients with PIV ≤ 7 mL (25th percentile) had mRS ≥ 3; 12/80 (15.0%) with PIV ≥ 72 mL (75th percentile) had mRS ≤ 2. Discrepant cases did not differ by CT versus MRI-based PIV ascertainment, or right versus left-hemisphere involvement ( p = 0.39, p = 0.81, respectively, for PIV ≤ 7 mL/mRS ≥ 3). Pre-treatment factors independently associated with small-PIV/mRS ≥ 3 included older age ( p = 0.010), cancer, and vascular risk-factors; post-treatment factors included 48-h NIHSS ( p = 0.007) and post-stroke complications ( p = 0.026). Absence of vascular risk-factors ( p = 0.004), CT-based lentiform nucleus sparing ( p = 0.002), lower 24-hour NIHSS ( p = 0.001), and absence of complications ( p = 0.013) were associated with large-PIV/mRS ≤ 2. Sensitivity analyses yielded similar results.
Conclusions: Discrepancies between functional ability and PIV are likely explained by differences in age, comorbidities, and post-stroke complications, emphasizing the need for high-quality post-thrombectomy stroke care.
Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT01778335.
