F S Al-Ajlan1,2, A S Al Sultan1, P Minhas1, Z Assis1, M A de Miquel3, M Millán4, L San Román5, A Tomassello6, A M Demchuk1, T G Jovin7, P Cuadras4, A Dávalos4, M Goyal1, B K Menon8. 1. From the Department of Clinical Neurosciences and Department of Radiology (F.S.A.-A., A.S.A.S., P.M., Z.A., A.M.D., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 2. Department of Neurosciences at King Faisal Specialist Hospital and Research Centre (F.S.A.-A.), Riyadh, Saudi Arabia. 3. Stroke Unit (M.A.d.M.), Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 4. Stroke Unit (M.M., P.C., A.D.), Department of Neurosciences and Department of Radiology, Hospital Germans Trias, Universitat Autosome de Barcelona, Badalona (Barcelona), Spain. 5. Stroke Unit (L.S.R.), Neurology Department, Hospital Clínic, Barcelona, Spain. 6. Stroke Unit (A.T.), Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain. 7. Stroke Institute (T.G.J.), Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 8. From the Department of Clinical Neurosciences and Department of Radiology (F.S.A.-A., A.S.A.S., P.M., Z.A., A.M.D., M.G., B.K.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada docbijoymenon@gmail.com.
Abstract
BACKGROUND AND PURPOSE:Endovascular therapy has become the standard of care for patients with disabling anterior circulation ischemic stroke due to proximal intracranial thrombi. Our aim was to determine whether the beneficial effect of endovascular treatment on functional outcome could be explained by a reduction in posttreatment infarct volume in the Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT) trial. MATERIALS AND METHODS: The REVASCAT trial was a multicenter randomized open-label trial with blinded outcome evaluation. Among 206 enrolled subjects (endovascular treatment, n = 103; control, n = 103), posttreatment infarct volume was measured in 204 subjects. Posttreatment infarct volumes were compared with treatment assignment and recanalization status. Appropriate statistical models were used to assess the relationship among baseline clinical and imaging variables, posttreatment infarct volume, the 24-hour NIHSS score, and functional status with the 90-day modified Rankin Scale score. RESULTS: The median posttreatment infarct volume in all subjects was 23.7 mL (interquartile range = 68.9 mL) and 16.3 mL (interquartile range = 50.2 mL) in the endovascular treatment arm and 38.6 mL (interquartile range = 74.9 mL) in the control arm (P = .02 for endovascular treatment versus control subjects). Baseline NIHSS (P < .01), site of occlusion (P < .03), baseline NCCT ASPECTS (P < .01), and recanalization status (P = .02) were independently associated with posttreatment infarct volume. Baseline NIHSS (P < .01), time from symptom onset to randomization (P = .02), treatment type (P = .04), and recanalization status (P < .01) were independently associated with the 24-hour NIHSS scores. The 24-hour NIHSS score strongly mediated the relationship between treatment type and 90-day mRS (P < .01 for indirect effect when adjusted for age), while posttreatment infarct volume did not (P = .26). CONCLUSIONS:Endovascular treatment saves brain and improves 90-day clinical outcomes primarily through a beneficial effect on the 24-hour stroke severity.
RCT Entities:
BACKGROUND AND PURPOSE: Endovascular therapy has become the standard of care for patients with disabling anterior circulation ischemic stroke due to proximal intracranial thrombi. Our aim was to determine whether the beneficial effect of endovascular treatment on functional outcome could be explained by a reduction in posttreatment infarct volume in the Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT) trial. MATERIALS AND METHODS: The REVASCAT trial was a multicenter randomized open-label trial with blinded outcome evaluation. Among 206 enrolled subjects (endovascular treatment, n = 103; control, n = 103), posttreatment infarct volume was measured in 204 subjects. Posttreatment infarct volumes were compared with treatment assignment and recanalization status. Appropriate statistical models were used to assess the relationship among baseline clinical and imaging variables, posttreatment infarct volume, the 24-hour NIHSS score, and functional status with the 90-day modified Rankin Scale score. RESULTS: The median posttreatment infarct volume in all subjects was 23.7 mL (interquartile range = 68.9 mL) and 16.3 mL (interquartile range = 50.2 mL) in the endovascular treatment arm and 38.6 mL (interquartile range = 74.9 mL) in the control arm (P = .02 for endovascular treatment versus control subjects). Baseline NIHSS (P < .01), site of occlusion (P < .03), baseline NCCT ASPECTS (P < .01), and recanalization status (P = .02) were independently associated with posttreatment infarct volume. Baseline NIHSS (P < .01), time from symptom onset to randomization (P = .02), treatment type (P = .04), and recanalization status (P < .01) were independently associated with the 24-hour NIHSS scores. The 24-hour NIHSS score strongly mediated the relationship between treatment type and 90-day mRS (P < .01 for indirect effect when adjusted for age), while posttreatment infarct volume did not (P = .26). CONCLUSIONS: Endovascular treatment saves brain and improves 90-day clinical outcomes primarily through a beneficial effect on the 24-hour stroke severity.
Authors: Ronen R Leker; Asaf Honig; Andrei Filioglo; Naaem Simaan; John M Gomori; Jose E Cohen Journal: Neuroradiology Date: 2020-10-06 Impact factor: 2.804
Authors: Anna M M Boers; Ivo G H Jansen; Scott Brown; Hester F Lingsma; Ludo F M Beenen; Thomas G Devlin; Luis San Román; Ji-Hoe Heo; Marc Ribó; Mohammed A Almekhlafi; David S Liebeskind; Jeanne Teitelbaum; Patricia Cuadras; Richard du Mesnil de Rochemont; Marine Beaumont; Martin M Brown; Albert J Yoo; Geoffrey A Donnan; Jean Louis Mas; Catherine Oppenheim; Richard J Dowling; Thierry Moulin; Nelly Agrinier; Demetrius K Lopes; Lucía Aja Rodríguez; Kars C J Compagne; Fahad S Al-Ajlan; Jeremy Madigan; Gregory W Albers; Sebastien Soize; Jordi Blasco; Stephen M Davis; Raul G Nogueira; Antoni Dávalos; Bijoy K Menon; Aad van der Lugt; Keith W Muir; Yvo B W E M Roos; Phil White; Peter J Mitchell; Andrew M Demchuk; Wim H van Zwam; Tudor G Jovin; Robert J van Oostenbrugge; Diederik W J Dippel; Bruce C V Campbell; Francis Guillemin; Serge Bracard; Michael D Hill; Mayank Goyal; Henk A Marquering; Charles B L M Majoie Journal: JAMA Neurol Date: 2019-02-01 Impact factor: 18.302
Authors: K C J Compagne; A M M Boers; H A Marquering; O A Berkhemer; A J Yoo; L F M Beenen; R J van Oostenbrugge; W H van Zwam; Y B W E M Roos; C B Majoie; A C G M van Es; A van der Lugt; D W J Dippel; H Lingsma Journal: Eur Radiol Date: 2018-07-09 Impact factor: 5.315
Authors: Aravind Ganesh; Johanna M Ospel; Bijoy K Menon; Andrew M Demchuk; Ryan A McTaggart; Raul G Nogueira; Alexandre Y Poppe; Mohammed A Almekhlafi; Ricardo A Hanel; Götz Thomalla; Staffan Holmin; Volker Puetz; Brian A van Adel; Jason W Tarpley; Michael Tymianski; Michael D Hill; Mayank Goyal Journal: JAMA Netw Open Date: 2021-11-01