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

Author:

Boers Anna M MORCID,Jansen Ivo G H,Beenen Ludo F M,Devlin Thomas G,San Roman Luis,Heo Ji Hoe,Ribó Marc,Brown Scott,Almekhlafi Mohammed A,Liebeskind David S,Teitelbaum Jeanne,Lingsma Hester F,van Zwam Wim HORCID,Cuadras Patricia,du Mesnil de Rochemont Richard,Beaumont Marine,Brown Martin M,Yoo Albert J,van Oostenbrugge Robert JORCID,Menon Bijoy KORCID,Donnan Geoffrey A,Mas Jean Louis,Roos Yvo B W E M,Oppenheim Catherine,van der Lugt AadORCID,Dowling Richard J,Hill Michael D,Davalos Antoni,Moulin Thierry,Agrinier Nelly,Demchuk Andrew M,Lopes Demetrius K,Aja Rodríguez Lucia,Dippel Diederik W JORCID,Campbell Bruce C V,Mitchell Peter J,Al-Ajlan Fahad S,Jovin Tudor G,Madigan Jeremy,Albers Gregory W,Soize Sebastien,Guillemin Francis,Reddy Vivek K,Bracard Serge,Blasco Jordi,Muir Keith W,Nogueira Raul G,White Phil M,Goyal Mayank,Davis Stephen M,Marquering Henk A,Majoie Charles B L M

Abstract

BackgroundFollow-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.ObjectiveTo examine the association of FIV with 90-day modified Rankin Scale (mRS) score and investigate its dependency on acquisition time and modality.MethodsData 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.ResultsOf 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).ConclusionsIn 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.

Funder

Medtronic

Publisher

BMJ

Subject

Clinical Neurology,General Medicine,Surgery

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