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

Boers, AMM; Jansen, IGH; Beenen, LFM; Devlin, TG; San Roman, L; Heo, JH; Ribó, M; Brown, S; Almekhlafi, MA; Liebeskind, DS; et al. Boers, AMM; Jansen, IGH; Beenen, LFM; Devlin, TG; San Roman, L; Heo, JH; Ribó, M; Brown, S; Almekhlafi, MA; Liebeskind, DS; Teitelbaum, J; Lingsma, HF; van Zwam, WH; Cuadras, P; du Mesnil de Rochemont, R; Beaumont, M; Brown, MM; Yoo, AJ; van Oostenbrugge, RJ; Menon, BK; Donnan, GA; Mas, JL; Roos, YBWEM; Oppenheim, C; van der Lugt, A; Dowling, RJ; Hill, MD; Davalos, A; Moulin, T; Agrinier, N; Demchuk, AM; Lopes, DK; Aja Rodríguez, L; Dippel, DWJ; Campbell, BCV; Mitchell, PJ; Al-Ajlan, FS; Jovin, TG; Madigan, J; Albers, GW; Soize, S; Guillemin, F; Reddy, VK; Bracard, S; Blasco, J; Muir, KW; Nogueira, RG; White, PM; Goyal, M; Davis, SM; Marquering, HA; Majoie, CBLM (2018) Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials. J Neurointerv Surg, 10 (12). pp. 1137-1142. ISSN 1759-8486 https://doi.org/10.1136/neurintsurg-2017-013724
SGUL Authors: Madigan, Jeremy

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Abstract

BACKGROUND: Follow-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. OBJECTIVE: To examine the association of FIV with 90-day modified Rankin Scale (mRS) score and investigate its dependency on acquisition time and modality. METHODS: Data 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. RESULTS: Of 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). CONCLUSIONS: In 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.

Item Type: Article
Additional Information: This article has been accepted for publication in JNIS following peer review. The definitive copyedited, typeset version Boers AMM, Jansen IGH, Beenen LFM, et al Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials Journal of NeuroInterventional Surgery 2018;10:1137-1142 is available online at: www.jnis.org
Keywords: brain, ct, mri, stroke, thrombectomy, brain, ct, mri, stroke, thrombectomy
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: J Neurointerv Surg
ISSN: 1759-8486
Language: eng
Dates:
DateEvent
December 2018Published
7 April 2018Published Online
2 March 2018Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
GNT1043242National Health and Medical Research Councilhttp://dx.doi.org/10.13039/501100000925
GNT1035688National Health and Medical Research Councilhttp://dx.doi.org/10.13039/501100000925
PubMed ID: 29627794
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110380
Publisher's version: https://doi.org/10.1136/neurintsurg-2017-013724

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