Al-Ajlan FS, Goyal M, Demchuk AM, Minhas P, Sabiq F, Assis Z, et al. Intra-Arterial Therapy and Post-Treatment Infarct Volumes: Insights From the ESCAPE Randomized Controlled Trial. Stroke. 2016
Outcome measurements in stroke trials commonly use measurements such as the mRS, NIHSS, or Barthel index as surrogates of functional improvement; the primary outcome measurement in the ESCAPE trial was the commonly used 3-month mRS. However, the relationship between outcomes at the functional level versus outcomes at a radiologic or anatomical level are not always delineated. Here, the authors perform a post-hoc analysis of the ESCAPE trial data, to evaluate the effect of IAT on saving brain tissue, and secondarily analyzed (1) clinical and imaging variables at baseline associated with post treatment infarct volume as well (2) the relationship between post treatment infarct volume and the 3-month mRS.
lower than the control group (15.5 mL vs 33.5 mL, p < 0.01). Similarly, regardless of the intervention, successful recanalization in both groups was associated with smaller infarct volumes (14.5 mL vs 35 mL, p < 0.01). Baseline variables that were independently associated with smaller post treatment infarct volume were baseline NIHSS, site of occlusion, baseline ASPECTS and recanalization status, while age, sex, treatment type, IV tPA and time from onset to randomization were not. Post treatment infarct volume was found to strongly predict the 3-month mRS, particularly when including the change from baseline NIHSS.