دورية أكاديمية
CT Perfusion Does Not Modify the Effect of Reperfusion in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment in the ESCAPE-NA1 Trial.
| العنوان: | CT Perfusion Does Not Modify the Effect of Reperfusion in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment in the ESCAPE-NA1 Trial. |
|---|---|
| المؤلفون: | Rex NB; From the Department of Diagnostic Imaging (N.B.R., R.A.M.), Brown University, Providence, Rhode Island.; Department of Diagnostic Imaging (N.B.R., R.V.M., J.M.O., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada., McDonough RV; Department of Diagnostic Imaging (N.B.R., R.V.M., J.M.O., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada., Ospel JM; Department of Diagnostic Imaging (N.B.R., R.V.M., J.M.O., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada.; Department of Clinical Neurosciences (J.M.O., A.S., J.C.F., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada., Kashani N; Department of Neurosurgery (N.K.), University of Saskatchewan, Saskatoon, Saskatchewan, Canada., Sehgal A; Department of Clinical Neurosciences (J.M.O., A.S., J.C.F., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada., Fladt JC; Department of Clinical Neurosciences (J.M.O., A.S., J.C.F., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada.; Department of Neurology and Stroke Center (J.C.F.), University Hospital Basel, Basel, Switzerland., McTaggart RA; From the Department of Diagnostic Imaging (N.B.R., R.A.M.), Brown University, Providence, Rhode Island., Nogueira R; Department of Neurology and Neurosurgery (R.N.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Menon B; Department of Diagnostic Imaging (N.B.R., R.V.M., J.M.O., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada.; Department of Clinical Neurosciences (J.M.O., A.S., J.C.F., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada., Demchuk AM; Department of Diagnostic Imaging (N.B.R., R.V.M., J.M.O., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada.; Department of Clinical Neurosciences (J.M.O., A.S., J.C.F., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada., Tymianski M; NoNO Inc (M.T.), Toronto, Ontario, Canada., Hill MD; Department of Diagnostic Imaging (N.B.R., R.V.M., J.M.O., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada.; Department of Clinical Neurosciences (J.M.O., A.S., J.C.F., B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada., Goyal M |
| مؤلفون مشاركون: | ESCAPE-NA1 Investigators |
| المصدر: | AJNR. American journal of neuroradiology [AJNR Am J Neuroradiol] 2023 Sep; Vol. 44 (9), pp. 1045-1049. Date of Electronic Publication: 2023 Aug 24. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Society of Neuroradiology Country of Publication: United States NLM ID: 8003708 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1936-959X (Electronic) Linking ISSN: 01956108 NLM ISO Abbreviation: AJNR Am J Neuroradiol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Oak Brook, IL : American Society of Neuroradiology Original Publication: Baltimore, Williams & Wilkins. |
| مواضيع طبية MeSH: | Ischemic Stroke*/diagnostic imaging , Ischemic Stroke*/drug therapy , Ischemic Stroke*/surgery , Stroke*/diagnostic imaging , Stroke*/drug therapy , Stroke*/surgery, Humans ; Hospitalization ; Reperfusion ; Tomography, X-Ray Computed |
| مستخلص: | Background and Purpose: Although reperfusion is associated with improved outcomes in patients with acute ischemic stroke undergoing endovascular treatment, many patients still do poorly. We investigated whether CTP modifies the effect of near-complete reperfusion on clinical outcomes, ie, whether poor clinical outcomes despite near-complete reperfusion can be partly or fully explained by CTP findings. Materials and Methods: Data are from the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial. Admission CTP was processed using RAPID software, generating relative CBF and CBV volume maps at standard thresholds. CTP lesion volumes were compared in patients with-versus-without near-complete reperfusion. Associations between each CTP metric and clinical outcome (90-day mRS) were tested using multivariable logistic regression, adjusted for baseline imaging and clinical variables. Treatment-effect modification was assessed by introducing CTP lesion volume × reperfusion interaction terms in the models. Results: CTP lesion volumes and reperfusion status were available in 410/1105 patients. CTP lesion volumes were overall larger in patients without near-complete reperfusion, albeit not always statistically significant. Increased CBF <34%, CBV <34%, CBV <38%, and CBV <42% lesion volumes were associated with worse clinical outcome (ordinal mRS) at 90 days. CTP core lesion volumes did not modify the treatment effect of near-complete recanalization on clinical outcome. Conclusions: CTP did not modify the effect of near-complete reperfusion on clinical outcomes. Thus, CTP cannot explain why some patients with near-complete reperfusion have poor clinical outcomes. (© 2023 by American Journal of Neuroradiology.) |
| References: | Lancet. 2020 Mar 14;395(10227):878-887. (PMID: 32087818) Interv Neurol. 2018 Oct;7(6):513-521. (PMID: 30410531) N Engl J Med. 2018 Feb 22;378(8):708-718. (PMID: 29364767) Stroke. 2017 Apr;48(4):932-938. (PMID: 28283606) Emerg Radiol. 2019 Aug;26(4):401-408. (PMID: 30929145) Neurology. 2021 Nov 16;97(20 Suppl 2):S60-S67. (PMID: 34785605) N Engl J Med. 2018 Jan 4;378(1):11-21. (PMID: 29129157) Stroke. 2020 Oct;51(10):3147-3155. (PMID: 32933417) Neurology. 2021 Sep 14;97(11):e1075-e1084. (PMID: 34261783) Stroke. 2015 Nov;46(11):3241-8. (PMID: 26443832) Neurotherapeutics. 2023 Apr;20(3):679-692. (PMID: 37014594) Stroke. 2015 Jun;46(6):1582-9. (PMID: 25908463) Eur Stroke J. 2022 Mar;7(1):I-XXVI. (PMID: 35300256) Stroke. 2019 Dec;50(12):e344-e418. (PMID: 31662037) |
| تواريخ الأحداث: | Date Created: 20230824 Date Completed: 20230913 Latest Revision: 20231003 |
| رمز التحديث: | 20240628 |
| مُعرف محوري في PubMed: | PMC10494951 |
| DOI: | 10.3174/ajnr.A7954 |
| PMID: | 37620153 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1936-959X |
|---|---|
| DOI: | 10.3174/ajnr.A7954 |