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Updated: May 9, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Age-adjusted infarct volume threshold for good outcome after endovascular treatment
Marc Ribo1, Alan Flores1, Eloy Mansilla1
1Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
Age-adjusted infarct size is a key predictor of stroke outcome in patients undergoing endovascular treatment. Smaller infarct volumes, tailored to patient age, significantly improve prognosis and guide future clinical trial design.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Infarct volume and patient age are critical determinants of stroke outcomes.
- Previous studies highlight their predictive value, but the interplay between age and infarct size requires further elucidation.
Purpose of the Study:
- To investigate the impact of infarct volume on stroke outcomes across different age groups.
- To establish age-specific infarct volume thresholds for predicting good outcomes after endovascular treatment.
Main Methods:
- A cohort of 214 patients with acute stroke and internal carotid artery/middle cerebral artery occlusion undergoing endovascular procedures was analyzed.
- Patients were stratified into three age groups: <70 years, 70-79 years, and ≥80 years.
- Initial CT scans assessed using the Alberta Stroke Program Early CT score (ASPECTS), with infarct volume measured at 24 hours post-procedure.
Main Results:
- Larger infarct volumes correlated with poorer outcomes across all age groups.
- Age-adjusted target infarct volumes for good outcomes decreased with increasing age (G1: 49 mL, G2: 32.5 mL, G3: 15.2 mL).
- Achieving a final infarct volume below the age-adjusted target was the sole significant predictor of a good outcome (OR 5.5), independent of other factors.
Conclusions:
- Age-adjusted infarct size serves as a potent surrogate marker for predicting stroke outcomes in patients receiving endovascular therapy.
- These findings can refine prognostic accuracy and inform the design of individualized selection criteria for clinical trials in stroke patients.
Background And Purpose:
Infarct volume and age are strong predictors of outcome in patients with stroke. We aimed to determine the impact of infarct volume on outcome according to age.
Methods:
Consecutive patients with acute stroke with documented internal carotid artery/middle cerebral artery occlusion who underwent endovascular procedures were studied. Patients were categorized in three age groups: <70 years (G1), 70-79 years (G2), ≥80 years (G3). The Alberta Stroke Program Early CT score (ASPECTS) was graded on initial CT. Time of successful recanalization (Thrombolysis In Cerebral Infarct (TICI) ≥2b )and good outcome at 3 months (modified Rankin Scale score ≤2) were recorded. Infarct volume was measured on the 24 h control CT.
Results:
A total of 214 patients were studied (G1: 68; G2: 74; G3: 72). For all patients the mean infarct volume was 94.7±127 mL; 35.6% had a good outcome. We observed larger infarct volumes in patients with a bad outcome in each age group (G1: 22 vs 182 mL, p<0.01/G2: 22 vs 164 mL, p<0.01/G3: 7.6 vs 132 mL, p<0.01). However, the target cut-off infarct volume that better predicted a good outcome decreased as age increased: G1: 49 mL (sensitivity 80%, specificity 92.6%); G2: 32.5 mL (sensitivity 80%, specificity 81%); G3: 15.2 mL (sensitivity 81.3%, specificity 86.7%). Overall, after adjusting for age, occlusion location, baseline NIH Stroke Scale score and infarct volume, the only predictor of a good outcome was achieving a final infarct volume less than the age-adjusted target (OR 5.5, 95% CI 1.6 to 18.8; p<0.01). The probability of achieving an infarct volume less than the age-adjusted target decreased according to baseline ASPECTS, time and degree of recanalization.
Conclusions:
Age-adjusted infarct size might represent a powerful surrogate marker of stroke outcome and further refine the predictive accuracy of infarct volume on prognosis in patients with stroke undergoing endovascular treatment. This information may be used in the design of new trials to individualize selection criteria for different age groups.
