Assessment of Discrepancies Between Follow-up Infarct Volume and 90-Day Outcomes Among Patients With Ischemic Stroke Who Received Endovascular Therapy

医学 冲程(发动机) 百分位 随机对照试验 不利影响 磁共振成像 改良兰金量表 队列 析因分析 内科学 物理疗法 放射科 缺血性中风 缺血 工程类 统计 机械工程 数学
作者
Aravind Ganesh,Johanna M. Ospel,Bijoy K. Menon,Andrew M. Demchuk,Ryan McTaggart,Raul G. Nogueira,Alexandre Y. Poppe,Mohammed Almekhlafi,Ricardó A. Hanel,Götz Thomalla,Staffan Holmin,Volker Puetz,Brian van Adel,Jason Tarpley,Michael Tymianski,Michael D. Hill,Mayank Goyal,Philip A. Barber,Eric E. Smith,Simerpreet Bal
出处
期刊:JAMA network open [American Medical Association]
卷期号:4 (11): e2132376-e2132376 被引量:25
标识
DOI:10.1001/jamanetworkopen.2021.32376
摘要

Importance

Some patients have poor outcomes despite small infarcts after endovascular therapy (EVT), while others with large infarcts do well. Understanding why these discrepancies occur may help to optimize EVT outcomes.

Objective

To validate exploratory findings from the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial regarding pretreatment, treatment-related, and posttreatment factors associated with discrepancies between follow-up infarct volume (FIV) and 90-day functional outcome.

Design, Setting, and Participants

This cohort study is a post hoc analysis of the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial, a double-blind, randomized, placebo-controlled, international, multicenter trial conducted from March 2017 to August 2019. Patients who participated in ESCAPE-NA1 and had available 90-day modified Rankin Scale (mRS) scores and 24-hour to 48-hour posttreatment follow-up parenchymal imaging were included.

Exposures

Small FIV (volume ≤25th percentile) and large FIV (volume ≥75th percentile) on 24-hour computed tomography/magnetic resonance imaging. Baseline factors, outcomes, treatments, and poststroke serious adverse events (SAEs) were compared between discrepant cases (ie, patients with 90-day mRS score ≥3 despite small FIV or those with mRS scores ≤2 despite large FIV) and nondiscrepant cases.

Main Outcomes and Measures

Area under the curve (AUC) and goodness of fit of prespecified logistic models, including pretreatment (eg, age, cancer, vascular risk factors) and treatment-related and posttreatment (eg, SAEs) factors, were compared with stepwise regression–derived models for ability to identify small FIV with higher mRS score and large FIV with lower mRS score.

Results

Among 1091 patients (median [IQR] age, 70.8 [60.8-79.8] years; 549 [49.7%] women; median [IQR] FIV, 24.9 mL [6.6-92.2 mL]), 42 of 287 patients (14.6%) with FIV of 7 mL or less (ie, ≤25th percentile) had an mRS score of at least 3; 65 of 275 patients (23.6%) with FIV of 92 mL or greater (ie, ≥75th percentile) had an mRS score of 2 or less. Prespecified models of pretreatment factors (ie, age, cancer, vascular risk factors) associated with low FIV and higher mRS score performed similarly to models selected by stepwise regression (AUC, 0.92 [95% CI, 0.89-0.95] vs 0.93 [95% CI, 0.90-0.95];P = .42). SAEs, specifically infarct in new territory, recurrent stroke, pneumonia, and congestive heart failure, were associated with low FIV and higher mRS scores; stepwise models also identified 24-hour hemoglobin as treatment-related/posttreatment factor (AUC, 0.92 [95% CI, 0.90-0.95] vs 0.94 [95% CI, 0.91-0.96];P = .14). Younger age was associated with high FIV and lower mRS score; stepwise models identified absence of diabetes and higher baseline hemoglobin as additional pretreatment factors (AUC, 0.76 [95% CI, 0.70-0.82] vs 0.77 [95% CI, 0.71-0.83];P = .82). Absence of SAEs, especially stroke progression, symptomatic intracerebral hemorrhage, and pneumonia, was associated with high FIV and lower mRS score2; stepwise models also identified 24-hour hemoglobin level, glucose, and diastolic blood pressure as posttreatment factors associated with discrepant cases (AUC, 0.80 [95% CI, 0.74-0.87] vs 0.79 [95% CI, 0.72-0.86];P = .92).

Conclusions and Relevance

In this study, discrepancies between functional outcome and post-EVT infarct volume were associated with differences in pretreatment factors, such as age and comorbidities, and posttreatment complications related to index stroke evolution, secondary prevention, and quality of stroke unit care. Besides preventing such complications, optimization of blood pressure, glucose levels, and hemoglobin levels are potentially modifiable factors meriting further study.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
JggHoo发布了新的文献求助10
3秒前
风轻青柠完成签到,获得积分10
3秒前
4秒前
6秒前
6秒前
量子星尘发布了新的文献求助10
6秒前
7秒前
R2L23发布了新的文献求助10
9秒前
9秒前
诚心的扬发布了新的文献求助10
10秒前
11秒前
liupc2019完成签到,获得积分10
12秒前
顾矜应助momo采纳,获得10
13秒前
周em12_发布了新的文献求助10
13秒前
14秒前
15秒前
15秒前
FashionBoy应助ZZZ采纳,获得10
16秒前
18秒前
清爽傲云发布了新的文献求助10
20秒前
20秒前
22秒前
24秒前
嗨嗨害发布了新的文献求助10
24秒前
Eileen发布了新的文献求助10
25秒前
呵呵哒发布了新的文献求助10
28秒前
清爽傲云完成签到,获得积分10
30秒前
30秒前
31秒前
momo发布了新的文献求助10
35秒前
诚心的扬关注了科研通微信公众号
36秒前
38秒前
嗨嗨害完成签到,获得积分10
39秒前
吧啦吧啦完成签到,获得积分10
39秒前
40秒前
41秒前
zero完成签到,获得积分10
42秒前
小二郎应助momo采纳,获得10
43秒前
hh完成签到 ,获得积分10
43秒前
大大完成签到 ,获得积分10
43秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3989297
求助须知:如何正确求助?哪些是违规求助? 3531418
关于积分的说明 11253893
捐赠科研通 3270097
什么是DOI,文献DOI怎么找? 1804884
邀请新用户注册赠送积分活动 882087
科研通“疑难数据库(出版商)”最低求助积分说明 809158