Background Determining infarct progression rate in acute ischemic stroke (AIS) is important for patient triage, treatment decision-making, and outcome prognostication.
Objective To estimate infarct progression rate in patients with AIS with large vessel occlusion (LVO) and determine its predictors and impact on clinical outcome.
Methods Data are from the ESCAPE-NA1 Trial. Patients with AIS with time from last known well to randomization <6 hours and near-complete reperfusion following endovascular treatment were included. Infarct growth rate (mL/h) was estimated by dividing 24 hour infarct volume (measured by non-contrast CT or diffusion-weighted magnetic resonance imaging) by time from last known well to reperfusion. Multivariable linear regression was used to assess the association of patient baseline variables with log-transformed infarct progression rate. The association of infarct progression rate and good outcome (modified Rankin Scale score 0–2) was determined using multivariable logistic regression.
Results Four hundred and nine patients were included in the study. Median infarct progression rate was 4.74 mL/h (IQR 1.25–14.84). Collateral status (β: −0.81 (95% CI −1.20 to −0.41)), Alberta Stroke Program Early CT Score (ASPECTS, β: −0.34 (95% CI −0.46 to −0.23)), blood glucose(β:0.09 (95% CI 0.02 to 0.16)), and National Institutes of Health Stroke Scale (NIHS score (β: 0.07 (95% CI 0.04 to 0.10)) were associated with log-transformed infarct progression rate. Clinical and imaging baseline variables explained 23% of the variance in infarct progression rate. Infarct progression rate was significantly associated with good outcome (aOR per 1 mL/h increase: 0.96 (95% CI 0.95 to 0.98)).
Conclusion In this sample of patients presenting within the early time window with LVO and near-complete recanalization, infarct progression rate was significantly associated with good outcome. A significant association between ASPECTS, collateral status, blood glucose, and NIHSS score was observed, but baseline imaging and clinical characteristics explained only a small proportion of the interindividual variance. More research on measurable factors affecting infarct growth is needed.
- CT angiography
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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JMO and RM contributed equally.
Collaborators the ESCAPE-NA1 investigators.
Contributors JMO, RM, MDH, MG: conceptualization, statistical analysis, drafting, and critical revision of the manuscript. All authors: data curation, critical revision of the manuscript.
Funding The ESCAPE-NA1 Trial was supported by: Canadian Institutes of Health Research; Alberta Innovates NoNo Inc.
Competing interests AMD: stock options and patients (Circle Neurovascular); honoraria for CME events (Boehringer Ingelheim); consultant (Medtronic). AYP: research grant to the institution (Stryker); payment/honoraria for lectures: C-CHANGE education program (update on stroke guidelines for general practitioners); participation on a data safety monitoring board or advisory board (FLOW trial); chair, Canadian Stroke Consortium National Stroke Fellowship Program. RGN: grant to Emory University (Cerenovus); consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron; consulting fees for medical legal consultations; stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse, and Perfuze; investor in Viz-AI, Perfuze, Cerebrotech, Reist LLC, Truvic, and Viseon. MVJ: treasurer, Society of Neurointerventional Surgery 2019–2021; vice president, Society of Neurointerventional Surgery 2021–present. MDH: grants to the University of Calgary for ESCAPE-NA1 (NoNO Inc); grants to the University of Calgary for ESCAPE-NA1 (CIHR); grants to the University of Calgary for ESCAPE-NA1 and the QuICR Alberta Stroke Program (Alberta Innovates); grants to the University of Calgary for TEMPO 2 (Boehringer Ingelheim); grants to the University of Calgary (Biogen); paid work for adjudication of clinical trial outcomes (Sun Pharma), US patent 62/086,077 and 10,916,346 (licensed to Circle Neurovascular); DSMC Chair (RACECAT, Oncovir Hiltonel, DUMAS Trials); DSMB member (ARTESIA, BRAIN-AF trials); president Canadian Neurological Sciences Federation (not for profit); board member founder and part ownership (Circle Neurovascular). MT: NoNO Inc. shareholder; president and CEO of NoNO Inc., owns patent for Nerinetide/NA1. MG: honoraria from Medtronic, Microvention, Mentice, and Stryker (teaching and advice on acute stroke intervention); ESCAPE-NA1 was funded through a grant to the University of Calgary from NoNO Inc.
Provenance and peer review Not commissioned; externally peer reviewed.
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