Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, November 15, 2021

Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial

 I could figure out nothing from this. Does EVT create brain atrophy? Or does existing brain atrophy change the success of EVT?

Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial

First Published October 28, 2021 Research Article 

Brain atrophy is suggested to impair the potential for functional recovery after acute ischemic stroke. We assessed whether the effect of endovascular treatment is modified by brain atrophy in patients with acute ischemic stroke due to large vessel occlusion.

We used data from MR CLEAN, a multicenter trial including patients with acute ischemic stroke due to anterior circulation large vessel occlusion randomized to endovascular treatment plus medical care (intervention) versus medical care alone (control). We segmented total brain volume (TBV) and intracranial volume (ICV) on baseline non-contrast computed tomography (n = 410). Next, we determined the degree of atrophy as the proportion of brain volume in relation to head size (1 − TBV/ICV) × 100%, analyzed as continuous variable and in tertiles. The primary outcome was a shift towards better functional outcome on the modified Rankin Scale expressed as adjusted common odds ratio. Treatment effect modification was tested using an interaction term between brain atrophy (as continuous variable) and treatment allocation.

We found that brain atrophy significantly modified the effect of endovascular treatment on functional outcome (P for interaction = 0.04). Endovascular treatment led to larger shifts towards better functional outcome in the higher compared to the lower range of atrophy (adjusted common odds ratio, 1.86 [95% CI: 0.97–3.56] in the lowest tertile vs. 1.97 [95% CI: 1.03–3.74] in the middle tertile vs. 3.15 [95% CI: 1.59–6.24] in the highest tertile).

Benefit of endovascular treatment is larger in the higher compared to the lower range of atrophy, demonstrating that advanced atrophy should not be used as an argument to withhold endovascular treatment.

Benefit of endovascular treatment (EVT) for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the anterior cerebral circulation has been demonstrated among a diverse variety of patient subgroups including older adults over age 80.1 This group currently makes up 25% of the stroke population receiving EVT in daily clinical practice.2 In these patients, brain atrophy is a common finding on diagnostic stroke imaging at hospital admission.3 Whether brain atrophy influences the effect of EVT, however, is undetermined.

Previous studies showed that in patients receiving EVT brain atrophy is independently associated with poor functional outcome,4,5 but modification of the effect of EVT by brain atrophy in clinical controlled trials has not been reported. Given that the age distribution of EVT-eligible patients is shifting towards older ages2,6 and will continue to do so over the next years due to aging of the population,7,8 atrophy will be encountered more frequently.9,10 This may be relevant for optimizing patient selection as brain atrophy may provide more individualized estimates of expected treatment benefit and clinical outcome as opposed to age.

Therefore, we investigated whether brain atrophy modifies the effect of EVT in patients with AIS due to LVO, and particularly, whether treatment benefit is uniform across the entire range of brain atrophy.

 
                                                                                                                                                        

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