J Stroke.  2024 May;26(2):252-259. 10.5853/jos.2023.02180.

How Do Quantitative Tissue Imaging Outcomes in Acute Ischemic Stroke Relate to Clinical Outcomes?

• Ospel JM
• Rinkel L
• Ganesh A
• Demchuk A
• Heran M
• Sauvageau E
• Joshi M
• Haussen D
• Jayaraman M
• Coutts S
• Yu A
• Puetz V
• Iancu D
• Bang OY
• Tarpley J
• Holmin S
• Kelly M
• Tymianski M
• Hill M
• Goyal M
• the ESCAPE-NA1 Investigators

• KMID: 2556045
• DOI: http://doi.org/10.5853/jos.2023.02180

Abstract

Background and Purpose
Infarct volume and other imaging markers are increasingly used as surrogate measures for clinical outcome in acute ischemic stroke research, but how improvements in these imaging surrogates translate into better clinical outcomes is currently unclear. We investigated how changes in infarct volume at 24 hours alter the probability of achieving good clinical outcome (modified Rankin Scale [mRS] 0–2).
Methods
Data are from endovascular thrombectomy patients from the randomized controlled ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke) trial. Infarct volume at 24 hours was manually segmented on non-contrast computed tomography or diffusion-weighted magnetic resonance imaging. Probabilities of achieving good outcome based on infarct volume were obtained from a multivariable logistic regression model. The probability of good outcome was plotted against infarct volume using linear spline regression.
Results
A total of 1,099 patients were included in the analysis (median final infarct volume 24.9 mL [interquartile range: 6.6–92.2]). The relationship between total infarct volume and good outcome probability was nearly linear for infarct volumes between 0 mL and 250 mL. In this range, a 10% increase in the probability of achieving mRS 0–2 required a decrease in infarct volume of approximately 34.0 mL (95% confidence interval: -32.5 to -35.6). At infarct volumes above 250 mL, the probability of achieving mRS 0–2 probability was near zero. The relationships of tissue-specific infarct volumes and parenchymal hemorrhage volume generally showed similar patterns, although variability was high.
Conclusion
There seems to be a near-linear association between total infarct volume and probability of achieving good outcome for infarcts up to 250 mL, whereas patients with infarct volumes greater than 250 mL are highly unlikely to have a favorable outcome.

Keyword

Acute stroke; Ischemia; Infarct volume; Thrombectomy

Figure

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  Figure 1. Probability of mRS 0–2 at 90 days as a function of total 24-hour infarct volume. (A) Adjusted probabilities of good clinical outcome (mRS 0–2 at 90 days) across the range of total 24-h infarct volumes from 0 mL to 500 mL (blue line) with corresponding 95% CIs (blue shaded area). Adjusted mRS probabilities were obtained from a binary logistic regression model with adjustment for patient age, sex, and baseline NIHSS. (B) Linear spline function modeling the association between total infarct volume and adjusted probability of achieving 90-day mRS 0–2. Knot at 250 mL was placed based on visual assessment and model fit parameters. Individual dots represent volumes and predicted probabilities of achieving mRS 0–2 for individual patients. Note that the x-axis in (A) and (B) was truncated at 500 mL for illustrative purposes. mRS, modified Rankin Scale; CI, confidence interval; NIHSS, National Institutes of Health Stroke Scale.

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  Figure 2. Adjusted probabilities for mRS 0–2 and respective confidence intervals and tissue-specific infarct and hemorrhage volumes. Adjusted probabilities of good clinical outcome (mRS 0–2 at 90 days) across the range of 24-h (A) grey matter infarct volumes, (B) white matter infarct volumes, and (C) parenchymal hemorrhage volumes. Note that the x-axes were truncated at 500 mL in (A) and 300 mL in (B) and (C) for illustrative purposes. Blue lines indicate adjusted probability of achieving mRS 0–2 and blue shaded areas indicate 95% CIs. Adjusted mRS probabilities were obtained from a binary logistic regression model (Supplementary Table 3). (D) A histogram of total infarct volumes in the patient sample. mRS, modified Rankin Scale; CI, confidence interval.

Reference

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