Infarcts in a New Territory: Insights From the ESCAPE-NA1 Trial

Area of Science:

• Neurology
• Interventional Radiology
• Stroke Medicine

Background:

• Endovascular stroke therapy is a common treatment for acute ischemic stroke.
• Infarct in a new territory (INT) is a recognized complication of this therapy.
• The incidence, outcomes, and impact of concurrent treatments on INT require further assessment.

Purpose of the Study:

• To determine the incidence of INT following endovascular stroke therapy.
• To evaluate the clinical outcomes associated with INT.
• To assess the influence of intravenous thrombolysis and nerinetide on INT.

Main Methods:

• Analysis of data from the ESCAPE-NA1 trial, a multicenter randomized study.
• INT identification through core lab imaging review of follow-up brain scans.
• Clinical outcomes (modified Rankin Scale, death) assessed using descriptive techniques and Poisson regression.

Main Results:

• INT occurred in 9.3% of 1092 patients, with no difference in baseline characteristics.
• Most INTs were not associated with visible occlusions and nearly 40% were larger than 20 mm.
• INT was linked to poorer functional outcomes (mRS 0-2) and increased risk of death.

Conclusions:

• INT is a frequent complication of endovascular thrombectomy for acute ischemic stroke.
• INT is associated with significantly poorer patient outcomes, including increased mortality.
• Developing strategies to minimize INT is essential for enhancing endovascular thrombectomy effectiveness.