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Abstract Details

Factors Associated with Discrepancy Between Post-treatment Infarct Volume and 90-day Functional Outcome in the ESCAPE Randomized Controlled Trial
Cerebrovascular Disease and Interventional Neurology
S47 - Stroke Outcomes and Recurrence (2:17 PM-2:28 PM)
008

Endovascular thrombectomy (EVT) likely improves functional ability in patients with acute ischemic stroke by saving at-risk brain tissue. However, some patients with small infarct volume after EVT have poor outcomes whilst others with large infarcts sometimes fare well.

To explore factors associated with discrepancies between functional ability and post-treatment infarct volume (PIV) in the ESCAPE trial.
We identified patients with small PIV≤25th percentile and large PIV≥75th percentile on 24-48-hour CT/MRI. Demographics, comorbidities, baseline stroke severity measured using NIHSS, stroke location, treatment type, post-stroke complications, 24-/48-hour severity (NIHSS), and other post-EVT outcome scales like the Barthel Index and EQ-5D were compared between “discrepant cases” – those with 90-day modified Rankin Scale (mRS)≤2 (good functional ability) despite large PIV or mRS>2 despite small PIV – and “non-discrepant cases”. Multi-variable logistic regression was used to identify pre-treatment and post-treatment factors associated with small-PIV/mRS>2 and large-PIV/mRS≤2. 

Among 315 patients, median PIV was 21mL. 27/79(34.2%) patients with PIV≤7mL (25th percentile) had mRS>2, and 12/80(15.0%) with PIV≥72mL (75th percentile) had mRS≤2. Discrepant cases did not differ significantly in CT versus MRI-based PIV ascertainment (p=0.39). Pre-treatment factors independently associated with small-PIV/mRS>2 included older age(p=0.028), cancer, vascular risk-factors (perfect predictors), and lower hemoglobin(p=0.043); post-treatment factors included 48-hour NIHSS(p=0.007) and post-stroke complications(p=0.026). Younger age(p<0.001), absence of vascular risk-factors(p=0.03), CT-based sparing of lentiform nucleus(p=0.017), lower 48-hour NIHSS(p=0.001), and absence of complications(p=0.005) were associated with large-PIV/mRS≤2.

Discrepancies between functional ability and PIV are likely explained by differences in pre-treatment factors like age and comorbidities, and post-treatment factors like the 48-hour NIHSS (likely reflecting functional eloquence) and post-stroke complications. Post-stroke complications were the only modifiable post-treatment factor consistently associated with discrepant outcomes, suggesting that high-quality post-acute care, aimed at preventing complications, may help optimize outcomes in patients receiving EVT.  

 
Authors/Disclosures
Aravind Ganesh, MD (Department of Clinical Neurosciences, University of Calgary)
PRESENTER 		Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MD Analytics. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MyMedicalPanel. Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Figure 1. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Atheneum. Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Creative Research Designs. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Servier Canada. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Ganesh has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Let's Get Proof (Collavidence Inc). Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生 (journals Neurology and Neurology: Clinical Practice). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association (journal: Stroke). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers (for Frontiers in Neurology). Dr. Ganesh has stock in SnapDx. Dr. Ganesh has stock in Collavidence Inc. Dr. Ganesh has stock in DataSimpl. The institution of Dr. Ganesh has received research support from Canadian Institutes of Health Research . The institution of Dr. Ganesh has received research support from Alberta Innovates. The institution of Dr. Ganesh has received research support from University of Calgary Centre for Clinical Research. The institution of Dr. Ganesh has received research support from Innovation 4 Health. The institution of Dr. Ganesh has received research support from Government of Canada INOVAIT. The institution of Dr. Ganesh has received research support from Campus Alberta Neuroscience. The institution of Dr. Ganesh has received research support from Alzheimer Society of Canada. The institution of Dr. Ganesh has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Ganesh has received research support from New Frontiers in Research Fund. The institution of Dr. Ganesh has received research support from Panmure House. The institution of Dr. Ganesh has received research support from Brain Canada. The institution of Dr. Ganesh has received research support from MSI Foundation. The institution of Dr. Ganesh has received research support from France Canada Research Fund. Dr. Ganesh has received intellectual property interests from a discovery or technology relating to health care.
Bijoy Menon, MD (University of Calgary) Dr. Menon has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Menon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Menon has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Circle NVI. Dr. Menon has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke VIN. Dr. Menon has stock in Circle NVI.
No disclosure on file
Andrew M. Demchuk, MD (Foothills Hospital/Calgary Stroke Program) Dr. Demchuk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Demchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lumosa. Dr. Demchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Pfizer/BMS. Dr. Demchuk has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boehringer Ingelheim. Dr. Demchuk has received stock or an ownership interest from Circle NVI. Dr. Demchuk has received intellectual property interests from a discovery or technology relating to health care.
Fahad S. Al-Ajlan, MD Dr. Al-Ajlan has nothing to disclose.
Mohammed Almekhlafi, MD (King Abdulaziz University Hospital) Dr. Almekhlafi has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Michael D. Hill, MD (University of Calgary) Dr. Hill has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boehringer Ingelheim. Dr. Hill has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sun Pharma. Dr. Hill has received stock or an ownership interest from Circle Neurovascular.
Mayank Goyal No disclosure on file
No disclosure on file