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

Anna M.M. Boers, Ivo G.H. Jansen, Ludo F.M. Beenen, Thomas G. Devlin, Luis San Roman, Ji Hoe Heo, Marc Ribo, Scott Brown, Mohammed A. Almekhlafi, David S. Liebeskind, Jeanne Teitelbaum, Hester F. Lingsma, Wim H. Van Zwam, Patricia Cuadras, Richard Du Mesnil De Rochemont, Marine Beaumont, Martin M. Brown, Albert J. Yoo, Robert J. Van Oostenbrugge, Bijoy K. MenonGeoffrey A. Donnan, Jean Louis Mas, Yvo B.W.E.M. Roos, Catherine Oppenheim, Aad Van Der Lugt, Richard J. Dowling, Michael D. Hill, Antoni Davalos, Thierry Moulin, Nelly Agrinier, Andrew M. Demchuk, Demetrius K. Lopes, Lucia Aja Rodriguez, Diederik W.J. Dippel, Bruce C.V. Campbell, Peter J. Mitchell, Fahad S. Al-Ajlan, Tudor G. Jovin, Jeremy Madigan, Gregory W. Albers, Sebastien Soize, Francis Guillemin, Vivek K. Reddy, Serge Bracard, Jordi Blasco, Keith W. Muir, Raul G. Nogueira, Phil M. White, Mayank Goyal, Stephen M. Davis, Henk A. Marquering, Charles B.L.M. Majoie

Research output: Contribution to journalArticle

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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 (?=0.60(95% CI 0.56 to 0.64) and ?=0.55(95% CI 0.50 to 0.60), respectively). Conclusions I n 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.

Original languageEnglish
Pages (from-to)1137-1142
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume10
Issue number12
DOIs
Publication statusPublished - 2018 Dec 1

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Stroke
Alberta
Outcome Assessment (Health Care)
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Boers, Anna M.M. ; Jansen, Ivo G.H. ; Beenen, Ludo F.M. ; Devlin, Thomas G. ; Roman, Luis San ; Heo, Ji Hoe ; Ribo, Marc ; Brown, Scott ; Almekhlafi, Mohammed A. ; Liebeskind, David S. ; Teitelbaum, Jeanne ; Lingsma, Hester F. ; Van Zwam, Wim H. ; Cuadras, Patricia ; De Rochemont, Richard Du Mesnil ; Beaumont, Marine ; Brown, Martin M. ; Yoo, Albert J. ; Van Oostenbrugge, Robert J. ; Menon, Bijoy K. ; Donnan, Geoffrey A. ; Mas, Jean Louis ; Roos, Yvo B.W.E.M. ; Oppenheim, Catherine ; Van Der Lugt, Aad ; Dowling, Richard J. ; Hill, Michael D. ; Davalos, Antoni ; Moulin, Thierry ; Agrinier, Nelly ; Demchuk, Andrew M. ; Lopes, Demetrius K. ; Rodriguez, Lucia Aja ; Dippel, Diederik W.J. ; Campbell, Bruce C.V. ; Mitchell, Peter J. ; Al-Ajlan, Fahad S. ; Jovin, Tudor G. ; Madigan, Jeremy ; Albers, Gregory W. ; Soize, Sebastien ; Guillemin, Francis ; Reddy, Vivek K. ; Bracard, Serge ; Blasco, Jordi ; Muir, Keith W. ; Nogueira, Raul G. ; White, Phil M. ; Goyal, Mayank ; Davis, Stephen M. ; Marquering, Henk A. ; Majoie, Charles B.L.M. / Association of follow-up infarct volume with functional outcome in acute ischemic stroke : A pooled analysis of seven randomized trials. In: Journal of NeuroInterventional Surgery. 2018 ; Vol. 10, No. 12. pp. 1137-1142.
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title = "Association of follow-up infarct volume with functional outcome in acute ischemic stroke: A pooled analysis of seven randomized trials",
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 (?=0.60(95{\%} CI 0.56 to 0.64) and ?=0.55(95{\%} CI 0.50 to 0.60), respectively). Conclusions I n 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.",
author = "Boers, {Anna M.M.} and Jansen, {Ivo G.H.} and Beenen, {Ludo F.M.} and Devlin, {Thomas G.} and Roman, {Luis San} and Heo, {Ji Hoe} and Marc Ribo and Scott Brown and Almekhlafi, {Mohammed A.} and Liebeskind, {David S.} and Jeanne Teitelbaum and Lingsma, {Hester F.} and {Van Zwam}, {Wim H.} and Patricia Cuadras and {De Rochemont}, {Richard Du Mesnil} and Marine Beaumont and Brown, {Martin M.} and Yoo, {Albert J.} and {Van Oostenbrugge}, {Robert J.} and Menon, {Bijoy K.} and Donnan, {Geoffrey A.} and Mas, {Jean Louis} and Roos, {Yvo B.W.E.M.} and Catherine Oppenheim and {Van Der Lugt}, Aad and Dowling, {Richard J.} and Hill, {Michael D.} and Antoni Davalos and Thierry Moulin and Nelly Agrinier and Demchuk, {Andrew M.} and Lopes, {Demetrius K.} and Rodriguez, {Lucia Aja} and Dippel, {Diederik W.J.} and Campbell, {Bruce C.V.} and Mitchell, {Peter J.} and Al-Ajlan, {Fahad S.} and Jovin, {Tudor G.} and Jeremy Madigan and Albers, {Gregory W.} and Sebastien Soize and Francis Guillemin and Reddy, {Vivek K.} and Serge Bracard and Jordi Blasco and Muir, {Keith W.} and Nogueira, {Raul G.} and White, {Phil M.} and Mayank Goyal and Davis, {Stephen M.} and Marquering, {Henk A.} and Majoie, {Charles B.L.M.}",
year = "2018",
month = "12",
day = "1",
doi = "10.1136/neurintsurg-2017-013724",
language = "English",
volume = "10",
pages = "1137--1142",
journal = "Journal of NeuroInterventional Surgery",
issn = "1759-8478",
publisher = "BMJ Publishing Group",
number = "12",

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Boers, AMM, Jansen, IGH, Beenen, LFM, Devlin, TG, Roman, LS, Heo, JH, Ribo, M, Brown, S, Almekhlafi, MA, Liebeskind, DS, Teitelbaum, J, Lingsma, HF, Van Zwam, WH, Cuadras, P, De Rochemont, RDM, 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, Rodriguez, LA, 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', Journal of NeuroInterventional Surgery, vol. 10, no. 12, pp. 1137-1142. https://doi.org/10.1136/neurintsurg-2017-013724

Association of follow-up infarct volume with functional outcome in acute ischemic stroke : A pooled analysis of seven randomized trials. / Boers, Anna M.M.; Jansen, Ivo G.H.; Beenen, Ludo F.M.; Devlin, Thomas G.; Roman, Luis San; Heo, Ji Hoe; Ribo, Marc; Brown, Scott; Almekhlafi, Mohammed A.; Liebeskind, David S.; Teitelbaum, Jeanne; Lingsma, Hester F.; Van Zwam, Wim H.; Cuadras, Patricia; De Rochemont, Richard Du Mesnil; Beaumont, Marine; Brown, Martin M.; Yoo, Albert J.; Van Oostenbrugge, Robert J.; Menon, Bijoy K.; Donnan, Geoffrey A.; Mas, Jean Louis; Roos, Yvo B.W.E.M.; Oppenheim, Catherine; Van Der Lugt, Aad; Dowling, Richard J.; Hill, Michael D.; Davalos, Antoni; Moulin, Thierry; Agrinier, Nelly; Demchuk, Andrew M.; Lopes, Demetrius K.; Rodriguez, Lucia Aja; Dippel, Diederik W.J.; Campbell, Bruce C.V.; Mitchell, Peter J.; Al-Ajlan, Fahad S.; Jovin, Tudor G.; Madigan, Jeremy; Albers, Gregory W.; Soize, Sebastien; Guillemin, Francis; Reddy, Vivek K.; Bracard, Serge; Blasco, Jordi; Muir, Keith W.; Nogueira, Raul G.; White, Phil M.; Goyal, Mayank; Davis, Stephen M.; Marquering, Henk A.; Majoie, Charles B.L.M.

In: Journal of NeuroInterventional Surgery, Vol. 10, No. 12, 01.12.2018, p. 1137-1142.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of follow-up infarct volume with functional outcome in acute ischemic stroke

T2 - A pooled analysis of seven randomized trials

AU - Boers, Anna M.M.

AU - Jansen, Ivo G.H.

AU - Beenen, Ludo F.M.

AU - Devlin, Thomas G.

AU - Roman, Luis San

AU - Heo, Ji Hoe

AU - Ribo, Marc

AU - Brown, Scott

AU - Almekhlafi, Mohammed A.

AU - Liebeskind, David S.

AU - Teitelbaum, Jeanne

AU - Lingsma, Hester F.

AU - Van Zwam, Wim H.

AU - Cuadras, Patricia

AU - De Rochemont, Richard Du Mesnil

AU - Beaumont, Marine

AU - Brown, Martin M.

AU - Yoo, Albert J.

AU - Van Oostenbrugge, Robert J.

AU - Menon, Bijoy K.

AU - Donnan, Geoffrey A.

AU - Mas, Jean Louis

AU - Roos, Yvo B.W.E.M.

AU - Oppenheim, Catherine

AU - Van Der Lugt, Aad

AU - Dowling, Richard J.

AU - Hill, Michael D.

AU - Davalos, Antoni

AU - Moulin, Thierry

AU - Agrinier, Nelly

AU - Demchuk, Andrew M.

AU - Lopes, Demetrius K.

AU - Rodriguez, Lucia Aja

AU - Dippel, Diederik W.J.

AU - Campbell, Bruce C.V.

AU - Mitchell, Peter J.

AU - Al-Ajlan, Fahad S.

AU - Jovin, Tudor G.

AU - Madigan, Jeremy

AU - Albers, Gregory W.

AU - Soize, Sebastien

AU - Guillemin, Francis

AU - Reddy, Vivek K.

AU - Bracard, Serge

AU - Blasco, Jordi

AU - Muir, Keith W.

AU - Nogueira, Raul G.

AU - White, Phil M.

AU - Goyal, Mayank

AU - Davis, Stephen M.

AU - Marquering, Henk A.

AU - Majoie, Charles B.L.M.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - 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 (?=0.60(95% CI 0.56 to 0.64) and ?=0.55(95% CI 0.50 to 0.60), respectively). Conclusions I n 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.

AB - 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 (?=0.60(95% CI 0.56 to 0.64) and ?=0.55(95% CI 0.50 to 0.60), respectively). Conclusions I n 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.

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UR - http://www.scopus.com/inward/citedby.url?scp=85048603002&partnerID=8YFLogxK

U2 - 10.1136/neurintsurg-2017-013724

DO - 10.1136/neurintsurg-2017-013724

M3 - Article

C2 - 29627794

AN - SCOPUS:85048603002

VL - 10

SP - 1137

EP - 1142

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

IS - 12

ER -