J M Ospel1,2, M D Hill1,3, B K Menon1,3, A Demchuk1,3, R McTaggart4, R Nogueira5, A Poppe6, D Haussen5, W Qiu1, A Mayank1, M Almekhlafi1,3, C Zerna1, M Joshi3, M Jayaraman4, D Roy6, J Rempel7, B Buck7, M Tymianski8, M Goyal9,3. 1. Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada. 2. Department of Radiology (J.M.O.), University Hospital of Basel, Basel, Switzerland. 3. Department of Radiology (M.D.H., B.K.M., A.D., M.A., M. Joshi, M.G.), University of Calgary, Calgary, Alberta, Canada. 4. Department of Interventional Radiology (R.M., M. Jayaraman), Warren Alpert Medical School of Brown University, Providence, Rhode Island. 5. Department of Neurology (R.N., D.H.), Emory University School of Medicine, Atlanta, Georgia. 6. Centre Hospitalier de l'Université de Montréal (A.P., D.R.), Montreal, Quebec, Canada. 7. University of Alberta Hospital (J.R., B.B.), Edmonton, Alberta, Canada. 8. NoNO Inc (M.T.), Toronto, Ontario, Canada. 9. Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada mgoyal@ucalgary.ca.
Abstract
BACKGROUND AND PURPOSE: Infarct volume is an important predictor of clinical outcome in acute stroke. We hypothesized that the association of infarct volume and clinical outcome changes with the magnitude of infarct size. MATERIALS AND METHODS: Data were derived from the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial, in which patients with acute stroke with large-vessel occlusion were randomized to endovascular treatment plus either nerinetide or a placebo. Infarct volume was manually segmented on 24-hour noncontrast CT or DWI. The relationship between infarct volume and good outcome, defined as mRS 0-2 at 90 days, was plotted. Patients were categorized on the basis of visual grouping at the curve shoulders of the infarct volume/outcome plot. The relationship between infarct volume and adjusted probability of good outcome was fitted with linear or polynomial functions as appropriate in each group. RESULTS: We included 1099 individuals in the study. Median infarct volume at 24 hours was 24.9 mL (interquartile range [IQR] = 6.6-92.2 mL). On the basis of the infarct volume/outcome plot, 4 infarct volume groups were defined (IQR = 0-15 mL, 15.1-70 mL, 70.1-200 mL, >200 mL). Proportions of good outcome in the 4 groups were 359/431 (83.3%), 219/337 (65.0%), 71/201 (35.3%), and 16/130 (12.3%), respectively. In small infarcts (IQR = 0-15 mL), no relationship with outcome was appreciated. In patients with intermediate infarct volume (IQR = 15-200 mL), there was progressive importance of volume as an outcome predictor. In infarcts of > 200 mL, outcomes were overall poor. CONCLUSIONS: The relationship between infarct volume and clinical outcome varies nonlinearly with the magnitude of infarct size. Infarct volume was linearly associated with decreased chances of achieving good outcome in patients with moderate-to-large infarcts, but not in those with small infarcts. In very large infarcts, a near-deterministic association with poor outcome was seen.
BACKGROUND AND PURPOSE: Infarct volume is an important predictor of clinical outcome in acute stroke. We hypothesized that the association of infarct volume and clinical outcome changes with the magnitude of infarct size. MATERIALS AND METHODS: Data were derived from the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial, in which patients with acute stroke with large-vessel occlusion were randomized to endovascular treatment plus either nerinetide or a placebo. Infarct volume was manually segmented on 24-hour noncontrast CT or DWI. The relationship between infarct volume and good outcome, defined as mRS 0-2 at 90 days, was plotted. Patients were categorized on the basis of visual grouping at the curve shoulders of the infarct volume/outcome plot. The relationship between infarct volume and adjusted probability of good outcome was fitted with linear or polynomial functions as appropriate in each group. RESULTS: We included 1099 individuals in the study. Median infarct volume at 24 hours was 24.9 mL (interquartile range [IQR] = 6.6-92.2 mL). On the basis of the infarct volume/outcome plot, 4 infarct volume groups were defined (IQR = 0-15 mL, 15.1-70 mL, 70.1-200 mL, >200 mL). Proportions of good outcome in the 4 groups were 359/431 (83.3%), 219/337 (65.0%), 71/201 (35.3%), and 16/130 (12.3%), respectively. In small infarcts (IQR = 0-15 mL), no relationship with outcome was appreciated. In patients with intermediate infarct volume (IQR = 15-200 mL), there was progressive importance of volume as an outcome predictor. In infarcts of > 200 mL, outcomes were overall poor. CONCLUSIONS: The relationship between infarct volume and clinical outcome varies nonlinearly with the magnitude of infarct size. Infarct volume was linearly associated with decreased chances of achieving good outcome in patients with moderate-to-large infarcts, but not in those with small infarcts. In very large infarcts, a near-deterministic association with poor outcome was seen.
Authors: Michelle Aarts; Yitao Liu; Lidong Liu; Shintaro Besshoh; Mark Arundine; James W Gurd; Yu-Tian Wang; Michael W Salter; Michael Tymianski Journal: Science Date: 2002-10-25 Impact factor: 47.728
Authors: Bijoy K Menon; Christopher D d'Esterre; Emmad M Qazi; Mohammed Almekhlafi; Leszek Hahn; Andrew M Demchuk; Mayank Goyal Journal: Radiology Date: 2015-01-29 Impact factor: 11.105
Authors: Fahad S Al-Ajlan; Mayank Goyal; Andrew M Demchuk; Priyanka Minhas; Farahna Sabiq; Zarina Assis; Robert Willinsky; Walter J Montanera; Jeremy L Rempel; Ashfaq Shuaib; John Thornton; David Williams; Daniel Roy; Alexandre Y Poppe; Tudor G Jovin; Biggya L Sapkota; Blaise W Baxter; Timo Krings; Frank L Silver; Donald F Frei; Christopher Fanale; Donatella Tampieri; Jeanne Teitelbaum; Cheemun Lum; Dar Dowlatshahi; Jai J Shankar; Philip A Barber; Michael D Hill; Bijoy K Menon Journal: Stroke Date: 2016-03 Impact factor: 7.914
Authors: Aravind Ganesh; Bijoy K Menon; Zarina A Assis; Andrew M Demchuk; Fahad S Al-Ajlan; Mohammed A Al-Mekhlafi; Jeremy L Rempel; Ashfaq Shuaib; Blaise W Baxter; Thomas Devlin; John Thornton; David Williams; Alexandre Y Poppe; Daniel Roy; Timo Krings; Leanne K Casaubon; Nima Kashani; Michael D Hill; Mayank Goyal Journal: Int J Stroke Date: 2020-06-09 Impact factor: 5.266
Authors: Anna M M Boers; Ivo G H Jansen; Henk A Marquering; Charles B L M Majoie; Ludo F M Beenen; Thomas G Devlin; Luis San Roman; Ji Hoe Heo; Marc Ribó; Scott Brown; Mohammed A Almekhlafi; David S Liebeskind; Jeanne Teitelbaum; Hester F Lingsma; Wim H van Zwam; Patricia Cuadras; Richard du Mesnil de Rochemont; Marine Beaumont; Martin M Brown; Albert J Yoo; Robert J van Oostenbrugge; Bijoy K Menon; Geoffrey A Donnan; Jean Louis Mas; Yvo B W E M Roos; Catherine Oppenheim; Aad van der Lugt; Richard J Dowling; Michael D Hill; Antoni Davalos; Thierry Moulin; Nelly Agrinier; Andrew M Demchuk; Demetrius K Lopes; Lucia Aja Rodríguez; Diederik W J Dippel; Bruce C V Campbell; Peter J Mitchell; Fahad S Al-Ajlan; Tudor G Jovin; Jeremy Madigan; Gregory W Albers; Sebastien Soize; Francis Guillemin; Vivek K Reddy; Serge Bracard; Jordi Blasco; Keith W Muir; Raul G Nogueira; Phil M White; Mayank Goyal; Stephen M Davis Journal: J Neurointerv Surg Date: 2018-04-07 Impact factor: 5.836
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
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Authors: Anna K Bonkhoff; Teresa Ullberg; Martin Bretzner; Sungmin Hong; Markus D Schirmer; Robert W Regenhardt; Kathleen L Donahue; Marco J Nardin; Adrian V Dalca; Anne-Katrin Giese; Mark R Etherton; Brandon L Hancock; Steven J T Mocking; Elissa C McIntosh; John Attia; John W Cole; Amanda Donatti; Christoph J Griessenauer; Laura Heitsch; Lukas Holmegaard; Katarina Jood; Jordi Jimenez-Conde; Steven J Kittner; Robin Lemmens; Christopher R Levi; Caitrin W McDonough; James F Meschia; Chia-Ling Phuah; Stefan Ropele; Jonathan Rosand; Jaume Roquer; Tatjana Rundek; Ralph L Sacco; Reinhold Schmidt; Pankaj Sharma; Agnieszka Slowik; Alessandro Sousa; Tara M Stanne; Daniel Strbian; Turgut Tatlisumak; Vincent Thijs; Achala Vagal; Daniel Woo; Ramin Zand; Patrick F McArdle; Bradford B Worrall; Christina Jern; Arne G Lindgren; Jane Maguire; Ona Wu; Petrea Frid; Natalia S Rost; Johan Wasselius Journal: Front Neurosci Date: 2022-08-25 Impact factor: 5.152