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Research ArticleNeurointervention

Correlation between Clinical Outcomes and Baseline CT and CT Angiographic Findings in the SWIFT PRIME Trial

A.P. Jadhav, H.-C. Diener, A. Bonafe, V.M. Pereira, E.I. Levy, B.W. Baxter, T.G. Jovin, R.G. Nogueira, D.R. Yavagal, C. Cognard, D.D. Purcell, B.K. Menon, R. Jahan, J.L. Saver and M. Goyal on behalf of the SWIFT PRIME investigators
American Journal of Neuroradiology October 2017, DOI: https://doi.org/10.3174/ajnr.A5406
A.P. Jadhav
aFrom Department of Neurology and Neurological Surgery (A.P.J., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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H.-C. Diener
bDepartment of Neurology (H.-C.D,), University Hospital of University Duisburg-Essen, Essen, Germany
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A. Bonafe
cDepartment of Neuroradiology (A.B.), Hôpital Gui-de-Chauliac, Montpellier, France
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V.M. Pereira
dDivision of Neuroradiology and Division of Neurosurgery (V.M.P.), Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
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E.I. Levy
eDepartment of Neurosurgery (E.I.L.), State University of New York at Buffalo, Buffalo, New York
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B.W. Baxter
fDepartment of Radiology (B.W.B.), Erlanger Hospital at University of Tennessee, Chattanooga, Tennessee
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T.G. Jovin
aFrom Department of Neurology and Neurological Surgery (A.P.J., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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R.G. Nogueira
gDepartment of Neurology (R.G.N.), Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
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D.R. Yavagal
hDepartment of Neurology and Neurosurgery (D.R.Y.), University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
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C. Cognard
iDepartment of Diagnostic and Therapeutic Neuroradiology (C.C.), University Hospital of Toulouse, Toulouse, France
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D.D. Purcell
jBioClinica (D.D.P.), Newark, California
kDepartment of Radiology (D.D.P.), California Pacific Medical Center, San Francisco, California
lDivision of Neuroradiology (D.D.P.), University of California San Francisco, San Francisco, California
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B.K. Menon
nNeurology and Neurosurgery (B.K.M.), University of Calgary, Calgary, Alberta, Canada
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R. Jahan
oDivision of Interventional Neuroradiology (R.J.)
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J.L. Saver
pDepartment of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, University of California, Los Angeles, Los Angeles, California.
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M. Goyal
mDepartments of Radiology and Clinical Neurosciences (M.G.)
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  • Fig 1.
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    Fig 1.

    Influence of baseline CT ASPECTS on outcome (90-day mRS), indicating better outcomes with higher ASPECTS and better outcome with endovascular therapy irrespective of ASPECTS.

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    Fig 2.

    Influence of the site of occlusion on outcome (90-day mRS), indicating better outcome with endovascular therapy irrespective of site and the greatest treatment effect in proximal M1 occlusions.

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    Fig 3.

    Outcomes (90-day mRS) in patients with a clot length of ≥8 mm, indicating statistically superior outcomes with endovascular therapy in these clots.

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    Fig 4.

    Influence of baseline collateral status on outcome (90-day mRS), indicating better outcomes with better collaterals, better outcomes with endovascular therapy irrespective of collateral quality, and the greatest treatment effect associated with excellent collaterals.

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    Fig 5.

    Mean mRS in dichotomized subgroups identified by classification and regression tree analysis indicating time to recanalization, initial ASPECTS, and TICI scores posttreatment as substantial predictors of outcome with the displayed cut-points for dichotomization.

Tables

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    Table 1:

    Univariate predictors of functional independence (mRS 0–2) at 90 days, endovascular arm onlya

    PredictorNo. TotalNo. CategoryOdds RatioLower CIUpper CIP Value
    ASPECTS (per unit)95NA1.531.092.15.015
    ASPECTS 8–10 (vs 6–7)9571/242.741.067.08.037
    ASPECTS 9–10 (vs 6–8)9552/433.431.458.09.005
    M1 occlusion (vs non-M1)9560/352.120.904.97.085
    Onset-to-groin puncture (per 60 min)94NA0.680.480.98.040
    TICI 3 postprocedure (vs ≤TICI 2b)8056/242.110.795.61.13
    TICI 2b/3 postprocedure (vs ≤TICI 2a)8070/101.800.476.82.39
    Collateral grade (per unit)56NA2.771.136.82.026
    Clot length (per mm)50NA1.120.961.30.14
    Clot length of ≥8 mm (vs <8 mm)5044/62.380.4213.40.32
    Clot length of ≥13 mm (vs <13 mm)5023/272.480.718.66.16
    • Note:—No. reflects the number of data points available for each variable; NA, not applicable.

    • ↵a Univariate logistic regression analysis of patients undergoing endovascular therapy was performed with the following variables: ASPECTS (as scored on preprocedural head CT, 6–7 vs 8–10 and 6–8 vs 9–10), site of occlusion (M1 versus non-M1), onset to groin puncture, quality of recanalization (TICI scale), collateral grade, and clot length (>8 mm versus <8 mm).

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    Table 2:

    Multivariate predictors of functional independence (mRS 0–2) at 90 days, endovascular arm onlya

    PredictorNo. TotalNo. CategoryOdds RatioLower CIUpper CIP Value
    ASPECTS 9–10 (vs 6–8)4828/204.251.0617.10.042
    Onset-to-groin puncture (per 60 min)48NA0.790.441.42.43
    TICI 2b/3 postprocedure (vs ≤TICI 2a)4843/51.030.128.46.98
    Collateral grade (per unit)48NA2.850.909.08.076
    • Note:—No. reflects the number of data points available for each variable; NA, not applicable.

    • ↵a Multivariate logistic regression analysis of patients undergoing endovascular therapy was performed with the following variables: ASPECTS (as scored on preprocedural head CT), onset to groin puncture, quality of recanalization (TICI scale), and collaterals.

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Cite this article
A.P. Jadhav, H.-C. Diener, A. Bonafe, V.M. Pereira, E.I. Levy, B.W. Baxter, T.G. Jovin, R.G. Nogueira, D.R. Yavagal, C. Cognard, D.D. Purcell, B.K. Menon, R. Jahan, J.L. Saver, M. Goyal
Correlation between Clinical Outcomes and Baseline CT and CT Angiographic Findings in the SWIFT PRIME Trial
American Journal of Neuroradiology Oct 2017, DOI: 10.3174/ajnr.A5406

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Correlation between Clinical Outcomes and Baseline CT and CT Angiographic Findings in the SWIFT PRIME Trial
A.P. Jadhav, H.-C. Diener, A. Bonafe, V.M. Pereira, E.I. Levy, B.W. Baxter, T.G. Jovin, R.G. Nogueira, D.R. Yavagal, C. Cognard, D.D. Purcell, B.K. Menon, R. Jahan, J.L. Saver, M. Goyal
American Journal of Neuroradiology Oct 2017, DOI: 10.3174/ajnr.A5406
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