Excellent recanalization and small core volumes are associated with favorable AMPAC score in patients with acute ischemic stroke secondary to large vessel occlusion

Abstract

AbstractBackground and aimAcute ischemic stroke due to large vessel occlusion (AIS-LVO) is a major cause of functional dependence, an important determinant of discharge disposition. The aim of this study is to assess the utility of pretreatment and interventional parameters as predictors of favorable Activity Measure for Post Acute Care (AMPAC) scores for optimal discharge planning.MethodsIn this retrospective multicenter analysis, inclusion criteria were as follows: a) CT angiography (CTA) confirmed LVO from 9/1/2017 to 9/22/2022; b) diagnostic CT perfusion; and c) available AMPAC scores. Patients were then dichotomized into favorable and unfavorable AMPAC for analysis. A multivariate logistic regression was performed using specific variables that were clinically relevant and significant on univariate regression analyses. A receiver operator characteristics (ROC) analysis was then performed to assess the diagnostic performance of the logistic regression model. A p value of <= 0.05 was considered significant.ResultsIn total, 229 patients (mean +-SD 70.65 +-15.2 [55.9% female]) met our inclusion criteria. Favorable AMPAC patients were younger (61.3 versus 70.7, p < 0.0001), had lower admission glucose (mean, 124.19 versus 136.83, p = 0.042), lower blood urea nitrogen (mean, 15.59 versus 19.11, p = 0.0009), and lower admission National Institutes of Health Stroke Scale (NIHSS) (mean, 10.58 versus 16.15, p < 0.0001). Multivariate regression analyses revealed age, admission NIHSS, relative cerebral blood flow (rCBF) < 30% volume, and modified thrombolysis in cerebral infarction (mTICI) score to be independent predictors of favorable AMPAC (p<0.047 for all predictors). ROC analysis of the combined model revealed an area under the curve (AUC) of 0.83 (IQR 0.75 - 0.86).ConclusionExcellent recanalization, smaller core volumes, younger age and lower stroke severity independently predict favorable outcomes as measured by AMPAC. Our study further emphasizes the significance of minimizing core volume and aiming for excellent recanalization in order to optimize discharge disposition in AIS-LVO patients.