Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials - Université de Lorraine Access content directly
Journal Articles Journal of Neurointerventional Surgery Year : 2018

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

1 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
2 University of Twente
3 UTC - University of Tennessee [Chattanooga]
4 University of Barcelona
5 Yonsei University
6 King Abdulaziz University
7 UCLA - University of California [Los Angeles]
8 Montreal Neurological Institute and Hospital
9 Erasmus MC - Erasmus University Medical Center [Rotterdam]
10 MUMC - Maastricht University Medical Centre
11 Frankfurt University of Applied Sciences
12 CIC-IT - Centre d'Investigation Clinique - Innovation Technologique [Nancy]
13 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
14 UCL - University College of London [London]
15 Texas Stroke Institute
16 University of Calgary
17 University of Melbourne
18 U894 - Centre de Psychiatrie et Neurosciences
19 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
20 CIC-EC - Centre d'investigation clinique - Epidémiologie clinique [Nancy]
21 Rush University Medical Center [Chicago]
22 IDIBELL - Institut d'Investigació Biomèdica de Bellvitge = Bellvitge Biomedical Research Institute
23 KFU - King Faisal University
24 PITT - University of Pittsburgh
25 St George’s University Hospitals
26 Stanford Stroke Center
27 Hôpital universitaire Robert Debré [Reims]
28 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
29 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
30 Hospital Clínic of Barcelona
31 University of Glasgow
32 Emory University School of Medicine
33 Newcastle University [Newcastle]
Ji Hoe Heo
  • Function : Author
Scott Brown
  • Function : Author
Wim van Zwam
Michael Hill
Keith Muir
  • Function : Author

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.

Dates and versions

hal-03225374 , version 1 (12-05-2021)

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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, 2018, 10 (12), pp.1137-1142. ⟨10.1136/neurintsurg-2017-013724⟩. ⟨hal-03225374⟩
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