Stroke Patients With Faster Core Growth Have Greater Benefit From Endovascular Therapy

 Wrong goal: mRS of 2 is not a good outcome.

Unless failure is acknowledged it will NEVER BE FIXED. This just normalizes failure.

THIS IS WHY SURVIVORS NEED TO BE IN CHARGE. We would never approve such crapola. 

mRS scale:

0  The patient has no residual symptoms.

1  The patient has no significant disability; able to carry out all pre-stroke activities.

2  The patient has slight disability; unable to carry out all pre-stroke activities but able to look after self without daily help.

3  The patient has moderate disability; requiring some external help but able to walk without the assistance of another individual.

4  The patient has moderately severe disability; unable to walk or attend to bodily functions without assistance of another individual.

5  The patient has severe disability; bedridden, incontinent, requires continuous care.

6  The patient has expired (during the hospital stay or after discharge from the hospital).

Stroke Patients With Faster Core Growth Have Greater Benefit From Endovascular Therapy

Longting Lin

,

Hao Zhang

,

Chushuang Chen

,

Andrew Bivard

,

Kenneth Butcher

,

Carlos Garcia-Esperon

,

Neil J. Spratt

,

Christopher R. Levi

,

Mark W. Parsons

,

Gang Li

,

and on behalf of INSPIRE Study Group‡

Originally published29 Sep 2021https://doi.org/10.1161/STROKEAHA.121.034205Stroke. 2021;52:3998–4006

• This article is commented on by the following:

Abstract

Background and Purpose:

This study aimed to explore whether the therapeutic benefit of endovascular thrombectomy (EVT) was mediated by core growth rate.

Methods:

This retrospective cohort study identified acute ischemic stroke patients with large vessel occlusion and receiving reperfusion treatment, either EVT or intravenous thrombolysis (IVT), within 4.5 hours of stroke onset. Patients were divided into 2 groups: EVT versus IVT only patients (who had no access to EVT). Core growth rate was estimated by the acute core volume on perfusion computed tomography divided by the time from stroke onset to perfusion computed tomography. The primary clinical outcome was good outcome defined by 3-month modified Rankin Scale score of 0–2. Tissue outcome was the final infarction volume.

Results:

A total of 806 patients were included, 429 in the EVT group (recanalization rate of 61.6%) and 377 in the IVT only group (recanalization rate of 44.7%). The treatment effect of EVT versus IVT only was mediated by core growth rate, showing a significant interaction between EVT treatment and core growth rate in predicting good clinical outcome (interaction odds ratio=1.03 [1.01–1.05], P=0.007) and final infarct volume (interaction odds ratio=−0.44 [−0.87 to −0.01], P=0.047). For patients with fast core growth of >25 mL/h, EVT treatment (compared with IVT only) increased the odds of good clinical outcome (adjusted odds ratio=3.62 [1.21–10.76], P=0.021) and resulted in smaller final infarction volume (37.5 versus 73.9 mL, P=0.012). For patients with slow core growth of <15 mL/h, there were no significant differences between the EVT and the IVT only group in either good clinical outcome (adjusted odds ratio=1.44 [0.97–2.14], P=0.070) or final infarction volume (22.6 versus 21.9 mL, P=0.551).

Conclusions:

Fast core growth was associated with greater benefit from EVT compared with IVT in the early <4.5-hour time window.

• Download figure
• Download PowerPoint