CT Perfusion Does Not Modify the Effect of Reperfusion in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment in the ESCAPE-NA1 Trial

N.B. Rex; R.V. McDonough; J.M. Ospel; N. Kashani; A. Sehgal; J.C. Fladt; R.A. McTaggart; R. Nogueira; B. Menon; A.M. Demchuk; M. Tymianski; M.D. Hill; M. Goyal

doi:10.3174/ajnr.A7954

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Table 1:

Baseline and treatment characteristics of patients with-versus-without near-complete reperfusion (eTICI 2c–3)

Variable	Near-Complete Reperfusion (n = 186)	No Near-Complete Reperfusion (n = 224)	P Value
Age (median) (IQR) (yr)	71.1 (61.2–80.1), n = 186	69.3 (58.4–79.6), n = 224	.12
Baseline NIHSS (median) (IQR)	18 (12–21), n = 186	17 (13–20), n = 224	.29
History of diabetes (No.) (%)	31/186 (16.7%)	46/224 (20.5%)	.55
History of past stroke/TIA (No.) (%)	24/186 (12.9%)	33/224 (14.7%)	.67
History of prior cardiac disease (No.) (%)	49/186 (26.3%)	47/224 (21.0%)	.24
Baseline ASPECTS (median) (IQR)	8 (7–9), n = 186	8 (6–8), n = 224	.13
Collateral score (No.) (%)			.06
Poor	2/186 (1.1%)	11/218 (5.1%)
Moderate	154/186 (82.8%)	178/218 (81.7%)
Good	30/186 (16.1%)	29/218 (13.3%)
Study drug to reperfusion time (median) (IQR) (min)	22 (9–39), n = 182	26 (12–52), n = 170	.17
Terminal ICA occlusion (No.) (%)	28/186 (15.1%)	44/223 (19.7%)	.24
IV alteplase (No.) (%)	110/186 (59.1%)	122/224 (54.5%)	.37
IV nerinetide (No.) (%)	89/186 (47.9%)	107/224 (47.8%)	1.00
Stent retriever as first-line device (No.) (%)	150/204 (73.5)	142/176 (80.7)	.103
Carotid stent placement during EVT	22/110 (20.0)	12/81 (14.8)	.445

Note:—IQR indicates interquartile range.

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Table 2:

CTP lesion volumes in patients with-versus-without near-complete reperfusion^{^a}

CTP Parameter (Median) (IQR)	Near-Complete Reperfusion (n = 186)	No Near-Complete Reperfusion (n = 224)	P Value
CBF <20%	0 (0–0)	0 (0–7.5)	<.01
CBF <30%	7.6 (0–28.1)	12.0 (0–32.1)	.06
CBF <34%	14.3 (2.7–39.4)	19.1 (5.2–47.2)	.10
CBF <38%	21.3 (7.1–54.8)	26.4 (9.9–60.9)	.20
CBV <34%	5.1 (0–28.1)	9.8 (0–33.3)	.07
CBV <38%	6.7 (0–35.6)	13.3 (0–39.0)	.048
CBV <42%	10.1 (0–41.2)	17.9 (4.6–46.0)	.06

Note:—IQR indicates interquartile range.
↵a Data in columns 2 and 3 are medians and interquartile ranges.

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Table 3:

CTP lesion volumes in patients with near-complete reperfusion who did and did not achieve good outcome at 90 days^{^a}

CTP Parameter(Median) (IQR)	Near-Complete Reperfusion with No Good Outcome (n = 54)	No Near-Complete Reperfusion with Good Outcome (n = 132)	P Value
CBF <20%	0 (0–6.9)	0 (0–0)	.02
CBF <30%	12.2 (4.4–38.6)	6.0 (0–22.2)	.01
CBF <34%	20.6 (8.1–53.0)	13.0 (0–33.6)	.02
CBF <38%	33.4 (13.4−73.0)	18.4 (6.6–46.4)	.0495
CBV <34%	12.2 (2.9–43.2)	0 (0–20.6)	<.01
CBV <38%	19.0 (4.9–54.2)	4.7 (0–23.1)	<.01
CBV <42%	21.8 (6.4–66.7)	6.5 (0–28.5)	<.01

Note:—IQR indicates interquartile range.
↵a When comparing the performance of multivariable logistic regression models in predicting good outcome at 90 days in patients with near-complete recanalization, model performance slightly increased and information loss decreased when CTP lesion volumes were added in addition to baseline variables, though the area under the curve confidence intervals overlapped (Table 4). Data in columns 2 and 3 are medians and interquartile ranges.

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Table 4:

Performance of multivariable logistic regression models without and with CTP lesion volumes in predicting good outcome at 90 days in patients with near-complete recanalization

Model	Pseudo-R²	BIC	AIC	AUC (95% CI)
Baseline variables only^{^a}	0.302	203.6	174.5	0.766 (0.718–0.813)
Baseline variables + CBF <20% volume	0.336	201.1	168.9	0.782 (0.735–0.829)
Baseline variables + CBF <30% volume	0.357	196.4	164.2	0.785 (0.739–0.831)
Baseline variables + CBF <34% volume	0.359	196.0	163.8	0.784 (0.738–0.830)
Baseline variables + CBF <38% volume	0.359	195.8	163.6	0.781 (0.735–0.828)
Baseline variables + CBV <34% volume	0.343	199.5	167.2	0.778 (0.731–0.824)
Baseline variables + CBV <38% volume	0.346	198.8	166.5	0.779 (0.732–0.825)
Baseline variables + CBV <42% volume	0.349	198.1	165.9	0.779 (0.732–0.825)

Note:—AIC indicates Akaike information criterion; BIC, Bayesian information criterion; AUC, area under the curve; Pseudo-R², pseudo-R squared.
↵a Baseline variables were prespecified and included age (in years), sex, NIHSS, treatment allocation (nerinetide versus placebo), alteplase treatment, baseline ASPECTS, collateral score (poor versus moderate versus good), and time from onset to CT imaging.