Background: Some patients do poorly despite small
infarcts after endovascular therapy(EVT) whilst others with large infarcts
do well. We validated exploratory findings from the ESCAPE trial regarding
factors associated with such discrepancies, in the ESCAPE-NA1
trial(NCT02930018). Methods: We identified
“discrepant cases” with modified Rankin Scale(mRS)≥3 despite small follow-up
infarct volume(FIV≤25th-percentile) on 24-hour CT/MRI or mRS≤2 despite large
FIV(volume≥75th-percentile). We compared area-under-the-curve(AUC) of
pre-specified logistic models containing (a)pre-treatment
factors(age/cancer/vascular risk-factors) and
(b)treatment-related/post-treatment factors(serious adverse events/SAEs) in
identifying small-FIV/mRS≥3 and large-FIV/mRS≤2, with stepwise
regression-derived models. Results: Among 1,091
patients, 42/287(14.6%) with FIV≤7mL(25th-percentile) had mRS≥3;
65/275(23.6%) with FIV≥92mL(75th-percentile) had mRS≤2. Pre-specified
pre-treatment factors(age/cancer/vascular risk-factors) were associated with
FIV≤7mL/mRS≥3; stepwise models selected similar variables(similar
AUCs:0.92-0.93,p=0.42). SAEs(infarct-in-new-territory/recurrent
stroke/pneumonia/heart failure) were strongly associated with FIV≤7mL/mRS≥3;
stepwise models also identified onset-to-needle time and
hemoglobin(24-hours) as treatment-related/post-treatment factors(similar
AUCs:0.92-0.94,p=0.14). Younger age was associated with FIV≥92mL/mRS≤2;
stepwise models also selected diabetes absence and baseline
hemoglobin(similar AUCs:0.76-0.77,p=0.82). Absence of SAEs(stroke
progression/pneumonia/intracerebral hemorrhage) was strongly associated with
FIV≥92mL/mRS≤2; stepwise models also identified 24-hour hemoglobin, glucose,
and BP(similar AUCs:0.79-0.80,p=0.030). Conclusions:
FIV-mRS discrepancies are associated with pre-treatment factors like
age/comorbidities; and post-treatment complications related to stroke
evolution, secondary prevention, and post-acute care quality. Optimizing
thrombolysis speed, BP, glucose, and hemoglobin are modifiable factors
meriting further study.