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

Lookup NU author(s): Professor Phil White



This is the authors' accepted manuscript of an article that has been published in its final definitive form by BMJ Group, 2018.

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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 FIVmeasurement.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 haemorrhage 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, by either CT or MRI.

Publication metadata

Author(s): Boers AMM, Jansen IGH, Beenen LF, et al

Publication type: Article

Publication status: Published

Journal: Journal of Neurointerventional Surgery

Year: 2018

Volume: 10

Issue: 12

Pages: 1137-1142

Print publication date: 20/11/2018

Online publication date: 07/04/2018

Acceptance date: 02/03/2018

Date deposited: 21/03/2018

ISSN (print): 1759-8478

ISSN (electronic): 1759-8486

Publisher: BMJ Group


DOI: 10.1136/neurintsurg-2017-013724


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