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Significance of Baseline Ischemic Core Volume on Stroke Outcome After Endovascular Therapy in Patients Age ≥75 Years: A Pooled Analysis of Individual Patient Data From 7 Trials
Age and infarct volume are strong predictors of outcome in patients with ischemic stroke who underwent endovascular therapy (EVT). We aimed to investigate the impact of ischemic core volume (ICV) on stroke outcome after EVT in elderly. Using the HERMES (Highly Effective Reperfusion Using Multiple En...
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| Published in: | Stroke (1970) 2022-12, Vol.53 (12), p.3564-3571 |
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| container_title | Stroke (1970) |
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| creator | Tanaka, Koji Goyal, Mayank Menon, Bijoy K. Campbell, Bruce C.V. Mitchell, Peter J. Jovin, Tudor G. Dávalos, Antoni Jansen, Olav Muir, Keith W. White, Phil M. Bracard, Serge Achit, Hamza Dippel, Diederik W.J. Majoie, Charles B.L.M. Hill, Michael D. Brown, Scott Demchuk, Andrew M. |
| description | Age and infarct volume are strong predictors of outcome in patients with ischemic stroke who underwent endovascular therapy (EVT). We aimed to investigate the impact of ischemic core volume (ICV) on stroke outcome after EVT in elderly.
Using the HERMES (Highly Effective Reperfusion Using Multiple Endovascular Devices) collaboration, a patient-level meta-analysis of 7 randomized trials in which patients were enrolled from December 2010 to April 2015) dataset, we categorized patients into those aged |
| doi_str_mv | 10.1161/STROKEAHA.122.039774 |
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Using the HERMES (Highly Effective Reperfusion Using Multiple Endovascular Devices) collaboration, a patient-level meta-analysis of 7 randomized trials in which patients were enrolled from December 2010 to April 2015) dataset, we categorized patients into those aged <75 and ≥75 years. ICV was calculated on computed tomography perfusion or magnetic resonance diffusion-weighted imaging. The association between ICV and the benefit of EVT over best medical treatment on outcome (modified Rankin Scale [mRS] at 90 days) and an ICV threshold for high likelihood (≥90%) of very poor outcome (mRS score ≥5) after EVT were investigated.
A total of 899 patients who had baseline ICV data, 247 patients aged ≥75 years, of which 118 were randomized in the EVT arm. Patients aged ≥75 years required smaller ICV to achieve mRS score ≤3 than those aged <75 years in the EVT arm (median 10.7 mL versus 23.9 mL,
<0.001). In patients aged ≥75 years, modeling of outcome in both treatment arms revealed potential loss of effect for EVT at ICV of ≥50 mL or ≥85 mL for achieving mRS score ≤3 or ≤4, respectively. Treatment effect of EVT was significant in ICV <50 mL for mRS ≤3 (odds ratio 2.38, 95% confidence interval 1.35-4.22). ICV ≥132 mL was a threshold for high likelihood of very poor outcome after EVT. However, EVT still predicted at least 30% rate of mRS ≤3 at 150 mL ICV if near-complete or complete reperfusion was achieved.
Baseline ICV has an impact on stroke outcome after EVT in the elderly, but elderly patients with large ICV may still benefit from EVT if near-complete or complete reperfusion is achieved. Young patients seem to benefit from EVT regardless of ICV status.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.122.039774</identifier><identifier>PMID: 36337054</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Brain Ischemia - diagnostic imaging ; Brain Ischemia - surgery ; Endovascular Procedures - methods ; Humans ; Randomized Controlled Trials as Topic ; Reperfusion ; Stroke - diagnostic imaging ; Stroke - surgery ; Thrombectomy - methods ; Treatment Outcome</subject><ispartof>Stroke (1970), 2022-12, Vol.53 (12), p.3564-3571</ispartof><rights>Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4497-8451f52cc9c10ca2246d07d9b8a193d3cc64c196f284d5e44a9dfd99d053d8d33</citedby><cites>FETCH-LOGICAL-c4497-8451f52cc9c10ca2246d07d9b8a193d3cc64c196f284d5e44a9dfd99d053d8d33</cites><orcidid>0000-0002-4930-7789 ; 0000-0001-6501-4057 ; 0000-0003-2949-5679 ; 0000-0002-3466-496X ; 0000-0002-6269-1543 ; 0000-0001-9535-022X ; 0000-0003-3632-9433 ; 0000-0002-2619-6975 ; 0000-0001-9060-2109 ; 0000-0002-0040-3251 ; 0000-0002-8337-7529 ; 0000-0002-7600-9568 ; 0000-0002-9234-3515 ; 0000-0002-7330-1942</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36337054$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tanaka, Koji</creatorcontrib><creatorcontrib>Goyal, Mayank</creatorcontrib><creatorcontrib>Menon, Bijoy K.</creatorcontrib><creatorcontrib>Campbell, Bruce C.V.</creatorcontrib><creatorcontrib>Mitchell, Peter J.</creatorcontrib><creatorcontrib>Jovin, Tudor G.</creatorcontrib><creatorcontrib>Dávalos, Antoni</creatorcontrib><creatorcontrib>Jansen, Olav</creatorcontrib><creatorcontrib>Muir, Keith W.</creatorcontrib><creatorcontrib>White, Phil M.</creatorcontrib><creatorcontrib>Bracard, Serge</creatorcontrib><creatorcontrib>Achit, Hamza</creatorcontrib><creatorcontrib>Dippel, Diederik W.J.</creatorcontrib><creatorcontrib>Majoie, Charles B.L.M.</creatorcontrib><creatorcontrib>Hill, Michael D.</creatorcontrib><creatorcontrib>Brown, Scott</creatorcontrib><creatorcontrib>Demchuk, Andrew M.</creatorcontrib><creatorcontrib>HERMES Collaborators</creatorcontrib><creatorcontrib>on behalf of the HERMES Collaborators</creatorcontrib><title>Significance of Baseline Ischemic Core Volume on Stroke Outcome After Endovascular Therapy in Patients Age ≥75 Years: A Pooled Analysis of Individual Patient Data From 7 Trials</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Age and infarct volume are strong predictors of outcome in patients with ischemic stroke who underwent endovascular therapy (EVT). We aimed to investigate the impact of ischemic core volume (ICV) on stroke outcome after EVT in elderly.
Using the HERMES (Highly Effective Reperfusion Using Multiple Endovascular Devices) collaboration, a patient-level meta-analysis of 7 randomized trials in which patients were enrolled from December 2010 to April 2015) dataset, we categorized patients into those aged <75 and ≥75 years. ICV was calculated on computed tomography perfusion or magnetic resonance diffusion-weighted imaging. The association between ICV and the benefit of EVT over best medical treatment on outcome (modified Rankin Scale [mRS] at 90 days) and an ICV threshold for high likelihood (≥90%) of very poor outcome (mRS score ≥5) after EVT were investigated.
A total of 899 patients who had baseline ICV data, 247 patients aged ≥75 years, of which 118 were randomized in the EVT arm. Patients aged ≥75 years required smaller ICV to achieve mRS score ≤3 than those aged <75 years in the EVT arm (median 10.7 mL versus 23.9 mL,
<0.001). In patients aged ≥75 years, modeling of outcome in both treatment arms revealed potential loss of effect for EVT at ICV of ≥50 mL or ≥85 mL for achieving mRS score ≤3 or ≤4, respectively. Treatment effect of EVT was significant in ICV <50 mL for mRS ≤3 (odds ratio 2.38, 95% confidence interval 1.35-4.22). ICV ≥132 mL was a threshold for high likelihood of very poor outcome after EVT. However, EVT still predicted at least 30% rate of mRS ≤3 at 150 mL ICV if near-complete or complete reperfusion was achieved.
Baseline ICV has an impact on stroke outcome after EVT in the elderly, but elderly patients with large ICV may still benefit from EVT if near-complete or complete reperfusion is achieved. Young patients seem to benefit from EVT regardless of ICV status.</description><subject>Aged</subject><subject>Brain Ischemia - diagnostic imaging</subject><subject>Brain Ischemia - surgery</subject><subject>Endovascular Procedures - methods</subject><subject>Humans</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Reperfusion</subject><subject>Stroke - diagnostic imaging</subject><subject>Stroke - surgery</subject><subject>Thrombectomy - methods</subject><subject>Treatment Outcome</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNpFkU1uE0EQhUeIiJjADRCqJZsx_Tc_zW4wDrESyRE2SKxGne6auEnPtNM9k8hH4CBcgCNxkkziJKye6um9Kqm-JHlHyZTSnH5crb8tT-fVSTWljE0Jl0UhXiQTmjGRipyVL5MJGd2UCSkPk9cx_iKEMF5mr5JDnnNekExMkr8re9nZxmrVaQTfwGcV0dkOYRH1BlurYeYDwg_vhnYMdLDqg79CWA699qNTNT0GmHfG36ioB6cCrDcY1HYHtoNz1Vvs-gjVJcK_33-KDH6iCvETVHDuvUMDVafcLtp4f3zRGXtjzaDcUxO-qF7BcfAtFLAOVrn4JjloRsG3j3qUfD-er2cn6dny62JWnaVaCFmkpchokzGtpaZEK8ZEbkhh5EWpqOSGa50LTWXesFKYDIVQ0jRGSkMybkrD-VHyYb93G_z1gLGvWxs1Oqc69EOsWcE5I1QyOkbFPqqDjzFgU2-DbVXY1ZTU97TqZ1r1SKve0xpr7x8vDBctmufSE57_e2-9G98cr9xwi6HeoHL9ph55kiIvSMoIY5SNU_pg8TtleaJs</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Tanaka, Koji</creator><creator>Goyal, Mayank</creator><creator>Menon, Bijoy K.</creator><creator>Campbell, Bruce C.V.</creator><creator>Mitchell, Peter J.</creator><creator>Jovin, Tudor G.</creator><creator>Dávalos, Antoni</creator><creator>Jansen, Olav</creator><creator>Muir, Keith W.</creator><creator>White, Phil M.</creator><creator>Bracard, Serge</creator><creator>Achit, Hamza</creator><creator>Dippel, Diederik W.J.</creator><creator>Majoie, Charles B.L.M.</creator><creator>Hill, Michael D.</creator><creator>Brown, Scott</creator><creator>Demchuk, Andrew M.</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4930-7789</orcidid><orcidid>https://orcid.org/0000-0001-6501-4057</orcidid><orcidid>https://orcid.org/0000-0003-2949-5679</orcidid><orcidid>https://orcid.org/0000-0002-3466-496X</orcidid><orcidid>https://orcid.org/0000-0002-6269-1543</orcidid><orcidid>https://orcid.org/0000-0001-9535-022X</orcidid><orcidid>https://orcid.org/0000-0003-3632-9433</orcidid><orcidid>https://orcid.org/0000-0002-2619-6975</orcidid><orcidid>https://orcid.org/0000-0001-9060-2109</orcidid><orcidid>https://orcid.org/0000-0002-0040-3251</orcidid><orcidid>https://orcid.org/0000-0002-8337-7529</orcidid><orcidid>https://orcid.org/0000-0002-7600-9568</orcidid><orcidid>https://orcid.org/0000-0002-9234-3515</orcidid><orcidid>https://orcid.org/0000-0002-7330-1942</orcidid></search><sort><creationdate>20221201</creationdate><title>Significance of Baseline Ischemic Core Volume on Stroke Outcome After Endovascular Therapy in Patients Age ≥75 Years: A Pooled Analysis of Individual Patient Data From 7 Trials</title><author>Tanaka, Koji ; 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We aimed to investigate the impact of ischemic core volume (ICV) on stroke outcome after EVT in elderly.
Using the HERMES (Highly Effective Reperfusion Using Multiple Endovascular Devices) collaboration, a patient-level meta-analysis of 7 randomized trials in which patients were enrolled from December 2010 to April 2015) dataset, we categorized patients into those aged <75 and ≥75 years. ICV was calculated on computed tomography perfusion or magnetic resonance diffusion-weighted imaging. The association between ICV and the benefit of EVT over best medical treatment on outcome (modified Rankin Scale [mRS] at 90 days) and an ICV threshold for high likelihood (≥90%) of very poor outcome (mRS score ≥5) after EVT were investigated.
A total of 899 patients who had baseline ICV data, 247 patients aged ≥75 years, of which 118 were randomized in the EVT arm. Patients aged ≥75 years required smaller ICV to achieve mRS score ≤3 than those aged <75 years in the EVT arm (median 10.7 mL versus 23.9 mL,
<0.001). In patients aged ≥75 years, modeling of outcome in both treatment arms revealed potential loss of effect for EVT at ICV of ≥50 mL or ≥85 mL for achieving mRS score ≤3 or ≤4, respectively. Treatment effect of EVT was significant in ICV <50 mL for mRS ≤3 (odds ratio 2.38, 95% confidence interval 1.35-4.22). ICV ≥132 mL was a threshold for high likelihood of very poor outcome after EVT. However, EVT still predicted at least 30% rate of mRS ≤3 at 150 mL ICV if near-complete or complete reperfusion was achieved.
Baseline ICV has an impact on stroke outcome after EVT in the elderly, but elderly patients with large ICV may still benefit from EVT if near-complete or complete reperfusion is achieved. Young patients seem to benefit from EVT regardless of ICV status.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>36337054</pmid><doi>10.1161/STROKEAHA.122.039774</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-4930-7789</orcidid><orcidid>https://orcid.org/0000-0001-6501-4057</orcidid><orcidid>https://orcid.org/0000-0003-2949-5679</orcidid><orcidid>https://orcid.org/0000-0002-3466-496X</orcidid><orcidid>https://orcid.org/0000-0002-6269-1543</orcidid><orcidid>https://orcid.org/0000-0001-9535-022X</orcidid><orcidid>https://orcid.org/0000-0003-3632-9433</orcidid><orcidid>https://orcid.org/0000-0002-2619-6975</orcidid><orcidid>https://orcid.org/0000-0001-9060-2109</orcidid><orcidid>https://orcid.org/0000-0002-0040-3251</orcidid><orcidid>https://orcid.org/0000-0002-8337-7529</orcidid><orcidid>https://orcid.org/0000-0002-7600-9568</orcidid><orcidid>https://orcid.org/0000-0002-9234-3515</orcidid><orcidid>https://orcid.org/0000-0002-7330-1942</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Alma/SFX Local Collection |
| subjects | Aged Brain Ischemia - diagnostic imaging Brain Ischemia - surgery Endovascular Procedures - methods Humans Randomized Controlled Trials as Topic Reperfusion Stroke - diagnostic imaging Stroke - surgery Thrombectomy - methods Treatment Outcome |
| title | Significance of Baseline Ischemic Core Volume on Stroke Outcome After Endovascular Therapy in Patients Age ≥75 Years: A Pooled Analysis of Individual Patient Data From 7 Trials |
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