Associations of Ischemic Lesion Volume With Functional Outcome in Patients With Acute Ischemic Stroke

Bucker, Amber; Boers, Anna M. M.; Bot, Joseph C.J.; Berkhemer, Olvert A.; Lingsma, Hester F.; Yoo, Albert J.; Zwam, Wim H. van; Oostenbrugge, Robert J. van; Lugt, Aad van der; Dippel, Diederik W.J.; Roos, Yvo B.W.E.M.; Majoie, Charles B. L. M.; Marquering, Henk A.

doi:10.1161/strokeaha.116.015156

Cited by 56 publications

(64 citation statements)

References 23 publications

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“…Also, follow-up imaging was demonstrated to be a good predictor and possibly superior to mTICI scores [36, 37]. However, it would be beneficial for both patient and caregiver to have an early indication of prognosis to improve patient-caregiver communication and manage expectations.…”

Section: Discussionmentioning

confidence: 99%

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

et al. 2018

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Background: Reperfusion status after intra-arterial thrombectomy (IAT) is a critical predictor of functional outcome after acute ischemic stroke. However, most prognostic models have not included a detailed assessment of reperfusion status after IAT. Objective: The aim of this work was to assess the association between successful reperfusion and clinical outcome. Methods: Clinical, radiological, and procedural variables of patients treated with IAT were extracted from our prospective stroke registry. The association with functional outcome using the modified Rankin Scale (mRS) after 3 months was assessed using multivariable logistic regression. An extension of the modified TICI score, eTICI, was used to classify reperfusion status. The prognostic value of reperfusion status after IAT in addition to age, stroke severity, imaging characteristics, treatment with intravenous thrombolysis, and time from symptom onset to the end of IAT was assessed with logistic regression and summarized with receiver operating characteristic curves. Results: In total, 119 patients were included (mean age 66 years). In multivariable analysis, age >80 years (OR 6.8, 95% CI 1.2–39.8), NIHSS at presentation >15 (OR 7.3, 95% CI 2.3–23.5), and incomplete reperfusion status (eTICI score <2C; OR 10.3, 95% CI 3.5–30.6) were the strongest predictors of a poor outcome (mRS 3–6). Adding reperfusion status to the model improved the prognostic accuracy (AUC 0.88, 95% CI 0.91–0.94). Our results indicate a large difference between using an eTICI cutoff of ≥2C versus ≥2B: a cutoff ≥2C improved the predictive value for a good clinical outcome (2C: positive predictive value, PPV, 0.78; 2B: PPV 0.32). Conclusion: Our results promote using reperfusion status for assessing prognosis in ischemic stroke patients treated with IAT. A model using eTICI ≥2C had greater PPV than eTICI ≥2B and could improve prognostic accuracy.

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Section: Discussionmentioning

confidence: 99%

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

et al. 2018

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“…Moreover, the optimal timing of FIV assessment is unclear. Imaging too early may prevent the accurate measurement of ischemic lesions that continue to grow 12. In contrast, FIV assessment on late (3–7 days) follow-up imaging might be artificially inflated due to cerebral edema.…”

Section: Introductionmentioning

confidence: 99%

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

Boers

Jansen

Beenen

et al. 2018

J NeuroIntervent Surg

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“…Fourteen (38%) were female. Median age was 61 years [IQR 52-69], presentation NIHSS was 19 [IQR [15][16][17][18][19][20][21], ASPECTS at baseline was 8 [IQR 7-9], and 19 (51%) patients had infarcts involving the left hemisphere.…”

Section: Resultsmentioning

confidence: 99%

“…Our study has limitations. FIV measurements, particularly on studies performed within a week after AIS, may be inflated due to edema . For this reason, we defined a substantial mismatch between “at risk” territory and FIV with a very generous threshold of 100 mL.…”

Section: Discussionmentioning

confidence: 99%

“…FIV measurements, particularly on studies performed within a week after AIS, may be inflated due to edema. 21 For this reason, we defined a substantial mismatch between "at risk" territory and FIV with a very generous threshold of 100 mL. In addition, we also looked at a clinical endpoint (90-day mRS) and again found a weak correlation with the volume of CTP "at risk" territory.…”

Section: Discussionmentioning

confidence: 99%

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Accuracy of “At Risk” Tissue Predictions Using CT Perfusion in Acute Large Vessel Occlusions

Lee

Yoo²,

Marquering

et al. 2019

Journal of Neuroimaging

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BACKGROUND AND PURPOSE The validity of CT perfusion (CTP) predictions of expected infarction volume (“at risk” tissue) without rapid recanalization remains poorly characterized. METHODS From the MR CLEAN trial, we included patients who underwent CTP without successful recanalization. “At risk” volume was defined as Tmax > 6 seconds and ischemic core as relative CBF < 30 (Olea Sphere). Coprimary outcomes were follow‐up infarct volume (FIV) on CT at 1‐5 days and 90‐day mRS. Data are presented as median [IQR] or OR [95% CI] unless otherwise specified. RESULTS Among 37 patients who met criteria, 14 (38%) were women, median age was 61 years [52‐69], NIHSS was 19 [15‐21], ASPECTS was 8 [7‐9], and onset to imaging was 160 minutes [39‐200]. Occlusion location was M1 for 22 (59%), ICA‐T in 10 (27%), and M2 in 4 (11%). In univariable analysis, “at risk” volume correlated poorly with FIV (r = .06, P = .77). Among patients with predicted “at risk” volume < 100 mL, 36% had FIV > 200 mL. In adjusted linear regression, NIHSS but not “at risk” volume was associated with FIV (Coef 12, P = .045; Coef –.15, P = .8). In adjusted logistic regression, NIHSS but not “at risk” volume was associated with mRS 0‐2 at 90 days (OR .7 [.5‐.99]; OR 1.0 [.99‐1.04]). CONCLUSION Predictions of “at‐risk” tissue using CTP may underestimate the natural history of infarction from acute large vessel occlusions. NIHSS may perform better as a predictor of clinical outcomes in patients without rapid recanalization.

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Associations of Ischemic Lesion Volume With Functional Outcome in Patients With Acute Ischemic Stroke

Abstract: URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758.

Cited by 56 publications

References 23 publications

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

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

Accuracy of “At Risk” Tissue Predictions Using CT Perfusion in Acute Large Vessel Occlusions

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