Discrepancy between post-treatment infarct volume and 90-day outcome in the ESCAPE randomized controlled trial.
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 (
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.
Published In/Presented At
Ganesh, A., Menon, B. K., Assis, Z. A., Demchuk, A. M., Al-Ajlan, F. S., Al-Mekhlafi, M. A., Rempel, J. L., Shuaib, A., Baxter, B. W., Devlin, T., Thornton, J., Williams, D., Poppe, A. Y., Roy, D., Krings, T., Casaubon, L. K., Kashani, N., Hill, M. D., & Goyal, M. (2021). Discrepancy between post-treatment infarct volume and 90-day outcome in the ESCAPE randomized controlled trial. International journal of stroke : official journal of the International Stroke Society, 16(5), 593–601. https://doi.org/10.1177/1747493020929943
Diagnosis | Medicine and Health Sciences | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology
Department of Radiology and Diagnostic Medical Imaging