Intra-Arterial Therapy and Post-Treatment Infarct Volumes: Insights From the ESCAPE Randomized Controlled Trial.
Publication/Presentation Date
3-1-2016
Abstract
BACKGROUND AND PURPOSE: The goal of reperfusion therapy in acute ischemic stroke is to limit brain infarction. The objective of this study was to investigate whether the beneficial effect of endovascular treatment on functional outcome could be explained by a reduction in post-treatment infarct volume.
METHODS: The Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial was a multicenter randomized open-label trial with blinded outcome evaluation. Among 315 enrolled subjects (endovascular treatment n=165; control n=150), 314 subject's infarct volumes at 24 to 48 hours on magnetic resonance imaging (n=254) or computed tomography (n=60) were measured. Post-treatment infarct volumes were compared by treatment assignment and recanalization/reperfusion status. Appropriate statistical models were used to assess relationship between baseline clinical and imaging variables, post-treatment infarct volume, and functional status at 90 days (modified Rankin Scale).
RESULTS: Median post-treatment infarct volume in all subjects was 21 mL (interquartile range =65 mL), in the intervention arm, 15.5 mL (interquartile range =41.5 mL), and in the control arm, 33.5 mL (interquartile range =84 mL; P0.05). Post-treatment infarct volume (P
CONCLUSIONS: These results support the primary results of the ESCAPE trial and show that the biological underpinning of the success of endovascular therapy is a reduction in infarct volume.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335.
Volume
47
Issue
3
First Page
777
Last Page
781
ISSN
1524-4628
Published In/Presented At
Al-Ajlan, F. S., Goyal, M., Demchuk, A. M., Minhas, P., Sabiq, F., Assis, Z., Willinsky, R., Montanera, W. J., Rempel, J. L., Shuaib, A., Thornton, J., Williams, D., Roy, D., Poppe, A. Y., Jovin, T. G., Sapkota, B. L., Baxter, B. W., Krings, T., Silver, F. L., Frei, D. F., … ESCAPE Trial Investigators (2016). Intra-Arterial Therapy and Post-Treatment Infarct Volumes: Insights From the ESCAPE Randomized Controlled Trial. Stroke, 47(3), 777–781. https://doi.org/10.1161/STROKEAHA.115.012424
Disciplines
Diagnosis | Medicine and Health Sciences | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology
PubMedID
26892284
Department(s)
Department of Radiology and Diagnostic Medical Imaging
Document Type
Article