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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Intra-Arterial Therapy and Post-Treatment Infarct Volumes: Insights From the ESCAPE Randomized Controlled Trial
Fahad S Al-Ajlan1, Mayank Goyal1, Andrew M Demchuk1
1From the Department of Clinical Neurosciences and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary (F.S.A.-A., M.G., A.M.D., P.M., F.S., Z.A., P.A.B., M.D.H., B.K.M.); Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary (M.D.H., B.K.M.); Department of Medical Imaging, UHN, Toronto Western Hospital, Toronto (R.W., W.J.M.); Department of Surgery (Neurosurgery), University of Alberta, Edmonton (J.L.R.); Department of Medicine (Neurology), University of Alberta, Edmonton (A.S.); Department of Neuroradiology, Beaumont Hospital and the Royal College of Surgeons in Ireland (J. Thornton); Department of Geriatric and Stroke Medicine, Beaumont Hospital and the Royal College of Surgeons in Ireland (D.W.); Department of Radiology, CHUM, University of Montreal, Montreal (D.R.); Department of Neurosciences, CHUM, University of Montreal, Montreal (A.Y.P.); Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh (T.G.J.); Division of Neurology, University of Tennessee, Chattanooga (B.L.S.); Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga (B.W.B.); Division of Radiology, UHN, Toronto Western Hospital, Toronto (T.K.); Division of Neurology, Department of Medicine, UHN, Toronto Western Hospital, Toronto (F.L.S., C.F.); Colorado Neurological Institute, Engelwood (D.F.F., D.T.); Montreal Neurological Institute, McGill University, Montreal (J. Teitelbaum); Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa (C.L.); Department of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa (D.D.); Department of Neuroradiology, Dalhousie University, Halifax (J.J.S.); and Hotchkiss Brain Institute, University of Calgary (M.G., A.M.D., P.A.B., M.D.H., B.K.M.).
Endovascular therapy for acute ischemic stroke significantly reduced post-treatment infarct volume compared to standard care. This reduction in brain infarction volume is the primary mechanism driving improved functional outcomes in stroke patients.
Area of Science:
- Neurology
- Interventional Radiology
- Stroke Medicine
Background:
- Acute ischemic stroke requires timely reperfusion to limit brain damage.
- Endovascular treatment aims to restore blood flow, but its impact on infarct volume requires further elucidation.
- The ESCAPE trial investigated the efficacy of endovascular treatment in specific stroke cases.
Purpose of the Study:
- To determine if the improved functional outcomes from endovascular treatment are attributable to a reduction in post-treatment infarct volume.
- To analyze the relationship between infarct volume, treatment, and patient outcomes.
Main Methods:
- The ESCAPE trial was a multicenter, randomized, open-label study.
- Infarct volumes were measured using MRI or CT in 314 patients 24-48 hours post-treatment.
- Statistical models assessed the link between clinical/imaging variables, infarct volume, and 90-day functional status (modified Rankin Scale).
Main Results:
- Median post-treatment infarct volume was significantly smaller in the endovascular arm (15.5 mL) versus the control arm (33.5 mL).
- Baseline stroke severity, occlusion site, ASPECTS score, and recanalization status independently predicted infarct volume.
- Reduced post-treatment infarct volume and improved NIH Stroke Scale scores independently predicted better 90-day functional outcomes.
Conclusions:
- Endovascular therapy effectively reduces infarct volume in acute ischemic stroke.
- The reduction in infarct volume is the biological basis for the observed improvements in functional outcomes with endovascular treatment.
- Findings support the primary results of the ESCAPE trial regarding the mechanism of endovascular therapy success.
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