PT  - JOURNAL ARTICLE
AU  - Rex, N.B.
AU  - McDonough, R.V.
AU  - Ospel, J.M.
AU  - Kashani, N.
AU  - Sehgal, A.
AU  - Fladt, J.C.
AU  - McTaggart, R.A.
AU  - Nogueira, R.
AU  - Menon, B.
AU  - Demchuk, A.M.
AU  - Tymianski, M.
AU  - Hill, M.D.
AU  - Goyal, M.
TI  - CT Perfusion Does Not Modify the Effect of Reperfusion in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment in the ESCAPE-NA1 Trial
AID  - 10.3174/ajnr.A7954
DP  - 2023 Sep 01
TA  - American Journal of Neuroradiology
PG  - 1045--1049
VI  - 44
IP  - 9
4099  - http://www.ajnr.org/content/44/9/1045.short
4100  - http://www.ajnr.org/content/44/9/1045.full
SO  - Am. J. Neuroradiol.2023 Sep 01; 44
AB  - BACKGROUND AND PURPOSE: Although reperfusion is associated with improved outcomes in patients with acute ischemic stroke undergoing endovascular treatment, many patients still do poorly. We investigated whether CTP modifies the effect of near-complete reperfusion on clinical outcomes, ie, whether poor clinical outcomes despite near-complete reperfusion can be partly or fully explained by CTP findings.MATERIALS AND METHODS: Data are from the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial. Admission CTP was processed using RAPID software, generating relative CBF and CBV volume maps at standard thresholds. CTP lesion volumes were compared in patients with-versus-without near-complete reperfusion. Associations between each CTP metric and clinical outcome (90-day mRS) were tested using multivariable logistic regression, adjusted for baseline imaging and clinical variables. Treatment-effect modification was assessed by introducing CTP lesion volume × reperfusion interaction terms in the models.RESULTS: CTP lesion volumes and reperfusion status were available in 410/1105 patients. CTP lesion volumes were overall larger in patients without near-complete reperfusion, albeit not always statistically significant. Increased CBF <34%, CBV <34%, CBV <38%, and CBV <42% lesion volumes were associated with worse clinical outcome (ordinal mRS) at 90 days. CTP core lesion volumes did not modify the treatment effect of near-complete recanalization on clinical outcome.CONCLUSIONS: CTP did not modify the effect of near-complete reperfusion on clinical outcomes. Thus, CTP cannot explain why some patients with near-complete reperfusion have poor clinical outcomes.AISacute ischemic strokeeTICIexpanded TICIEVTendovascular treatmentLVOlarge-vessel occlusionrCBFrelative CBF