Aravind Ganesh1, Bijoy K Menon1,2,3,4, Zarina A Assis1,2, Andrew M Demchuk1,2,4, Fahad S Al-Ajlan5, Mohammed A Al-Mekhlafi1,2,4, Jeremy L Rempel6, Ashfaq Shuaib7, Blaise W Baxter8, Thomas Devlin9, John Thornton10, David Williams11, Alexandre Y Poppe12, Daniel Roy13, Timo Krings14, Leanne K Casaubon15, Nima Kashani1,2, Michael D Hill1,2,3,4, Mayank Goyal1,2,4. 1. Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. 2. Department of Radiology, University of Calgary, Calgary, Canada. 3. Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Canada. 4. Hotchkiss Brain Institute, Calgary, Canada. 5. Department of Neurosciences, King Faisal Specialist Hospital, Riyadh, Saudi Arabia. 6. Department of Radiology, University of Alberta, Edmonton, Canada. 7. Stroke Program and Department of Medicine, University of Alberta, Edmonton, Canada. 8. Department of Radiology, University of Tennessee, Erlanger Hospital, Knoxville, TN, USA. 9. Department of Neurology, University of Tennessee, Erlanger Hospital, Knoxville, TN, USA. 10. Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin, Ireland. 11. Department of Geriatric & Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland. 12. Department of Neurosciences, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Canada. 13. Department of Radiology, CHUM, Université de Montréal, Montreal, Canada. 14. Department of Medical Imaging, University Health Network, University of Toronto, Toronto Western Hospital, Toronto, Canada. 15. Division of Neurology, Stroke Program, University Health Network, University of Toronto, Toronto Western Hospital, Toronto, Canada.
Abstract
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.
RCT Entities:
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.
Authors: M Goyal; J Kromm; A Ganesh; C Wira; A Southerland; K N Sheth; H Khosravani; P Panagos; N McNair; J M Ospel Journal: AJNR Am J Neuroradiol Date: 2020-10-08 Impact factor: 3.825
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
Authors: J M Ospel; M D Hill; B K Menon; A Demchuk; R McTaggart; R Nogueira; A Poppe; D Haussen; W Qiu; A Mayank; M Almekhlafi; C Zerna; M Joshi; M Jayaraman; D Roy; J Rempel; B Buck; M Tymianski; M Goyal Journal: AJNR Am J Neuroradiol Date: 2021-06-24 Impact factor: 4.966