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Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials

Anna Boers 1, 2 Ivo Jansen 1 Ludo Beenen 1 Thomas Devlin 3 Luis San Roman 4 Ji Hoe Heo 5 Marc Ribó 4 Scott Brown Mohammed Almekhlafi 6 David Liebeskind 7 Jeanne Teitelbaum 8 Hester Lingsma 9 Wim van Zwam 10 Patricia Cuadras 4 Richard Du Mesnil de Rochemont 11 Marine Beaumont 12, 13 Martin Brown 14 Albert yoo 15 Robert van Oostenbrugge 10 Bijoy Menon 16 Geoffrey Donnan 17 Jean Louis Mas 18 yvo Roos 1 Catherine Oppenheim 18 Aad van Der Lugt 9 Richard Dowling 17 Michael Hill 16 Antoni Davalos 4 Thierry Moulin 19 Nelly Agrinier 20 Andrew Demchuk 16 Demetrius Lopes 21 Lucia Aja Rodríguez 22 Diederik Dippel 9 Bruce Campbell 17 Peter Mitchell 17 Fahad Al-Ajlan 23 Tudor Jovin 24 Jeremy Madigan 25 Gregory Albers 26 Sebastien Soize 27 Francis Guillemin 28, 13 Vivek Reddy 24 Serge Bracard 13, 29 Jordi Blasco 30 Keith Muir 31 Raul Nogueira 32 Phil White 33 Mayank Goyal 16 Stephen Davis 17 Henk Marquering 1 Charles Majoie 1 
Abstract : Background Follow-up infarct volume (FIV) has been recommended as an early indicator of treatment efficacy in patients with acute ischemic stroke. Questions remain about the optimal imaging approach for FIV measurement. Objective To examine the association of FIV with 90-day modified Rankin Scale (mRS) score and investigate its dependency on acquisition time and modality. Methods Data of seven trials were pooled. FIV was assessed on follow-up (12 hours to 2 weeks) CT or MRI. Infarct location was defined as laterality and involvement of the Alberta Stroke Program Early CT Score regions. Relative quality and strength of multivariable regression models of the association between FIV and functional outcome were assessed. Dependency of imaging modality and acquisition time (≤48 hours vs >48 hours) was evaluated. Results Of 1665 included patients, 83% were imaged with CT. Median FIV was 41 mL (IQR 14–120). A large FIV was associated with worse functional outcome (OR=0.88(95% CI 0.87 to 0.89) per 10 mL) in adjusted analysis. A model including FIV, location, and hemorrhage type best predicted mRS score. FIV of ≥133 mL was highly specific for unfavorable outcome. FIV was equally strongly associated with mRS score for assessment on CT and MRI, even though large differences in volume were present (48 mL (IQR 15–131) vs 22 mL (IQR 8–71), respectively). Associations of both early and late FIV assessments with outcome were similar in strength (ρ=0.60(95% CI 0.56 to 0.64) and ρ=0.55(95% CI 0.50 to 0.60), respectively). Conclusions In patients with an acute ischemic stroke due to a proximal intracranial occlusion of the anterior circulation, FIV is a strong independent predictor of functional outcome and can be assessed before 48 hours, oneither CT or MRI.
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Submitted on : Wednesday, May 12, 2021 - 2:34:07 PM
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Anna Boers, Ivo Jansen, Ludo Beenen, Thomas Devlin, Luis San Roman, et al.. Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials. Journal of Neurointerventional Surgery, BMJ Journals, 2018, 10 (12), pp.1137-1142. ⟨10.1136/neurintsurg-2017-013724⟩. ⟨hal-03225374⟩



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