Clinical and therapeutic variables may influence the association between infarct core predicted by CT perfusion and clinical outcome in acute stroke

Objectives: After an acute ischemic stroke, patients with a large CT perfusion (CTP) predicted infarct core (pIC) have poor clinical outcome. However, previous research suggests that this relationship may be relevant for subgroups of patients determined by pretreatment and treatment-related variable...

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Autores: Laredo Gregorio, Carlos, Solanes, Aleix, Renú, Arturo, Rudilosso, Salvatore, Llull Estrany, Laura, López Rueda, Antonio, Macías, Napoleón G., Rodriguez, Alejandro, Urra, Xabier, Obach, Víctor, Pariente, Jose Carlos, Chamorro Sánchez, Ángel, Radua, Joaquim, Amaro Delgado, Sergio
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/216198
Acceso en línea:https://hdl.handle.net/2445/216198
Access Level:acceso abierto
Palabra clave:Isquèmia cerebral
Trombosi
Malalties cerebrovasculars
Circulació cerebral
Cerebral ischemia
Thrombosis
Cerebrovascular disease
Cerebral circulation
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spelling Clinical and therapeutic variables may influence the association between infarct core predicted by CT perfusion and clinical outcome in acute strokeLaredo Gregorio, CarlosSolanes, AleixRenú, ArturoRudilosso, SalvatoreLlull Estrany, LauraLópez Rueda, AntonioMacías, Napoleón G.Rodriguez, AlejandroUrra, XabierObach, VíctorPariente, Jose CarlosChamorro Sánchez, ÁngelRadua, JoaquimAmaro Delgado, SergioIsquèmia cerebralTrombosiMalalties cerebrovascularsCirculació cerebralCerebral ischemiaThrombosisCerebrovascular diseaseCerebral circulationObjectives: After an acute ischemic stroke, patients with a large CT perfusion (CTP) predicted infarct core (pIC) have poor clinical outcome. However, previous research suggests that this relationship may be relevant for subgroups of patients determined by pretreatment and treatment-related variables while negligible for others. We aimed to identify these variables. Methods: We included a cohort of 828 patients with acute proximal carotid arterial occlusions imaged with a whole-brain CTP within 8 h from stroke onset. pIC was computed on CTP Maps (cerebral blood flow < 30%), and poor clinical outcome was defined as a 90-day modified Rankin Scale score > 2. Potential mediators of the association between pIC and clinical outcome were evaluated through first-order and advanced interaction analyses in the derivation cohort (n = 654) for obtaining a prediction model. The derived model was further validated in an independent cohort (n = 174). Results: The volume of pIC was significantly associated with poor clinical outcome (OR = 2.19, 95% CI = 1.73 - 2.78, p < 0.001). The strength of this association depended on baseline National Institute of Health Stroke Scale, glucose levels, the use of thrombectomy, and the interaction of age with thrombectomy. The model combining these variables showed good discrimination for predicting clinical outcome in both the derivation cohort and validation cohorts (area under the receiver operating characteristic curve 0.780 (95% CI = 0.746-0.815) and 0.782 (95% CI = 0.715-0.850), respectively). Conclusions: In patients imaged within 8 h from stroke onset, the association between pIC and clinical outcome is significantly modified by baseline and therapeutic variables. These variables deserve consideration when evaluating the prognostic relevance of pIC. Key points: •The volume of CT perfusion (CTP) predicted infarct core (pIC) is associated with poor clinical outcome in acute ischemic stroke imaged within 8 h of onset. •The relationship between pIC and clinical outcome may be modified by baseline clinical severity, glucose levels, thrombectomy use, and the interaction of age with thrombectomy. •CTP pIC should be evaluated in an individual basis for predicting clinical outcome in patients imaged within 8 h from stroke onset.Springer Verlag2024202420222024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion10 p.application/pdfhttps://hdl.handle.net/2445/216198Articles publicats en revistes (Medicina)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1007/s00330-022-08590-0European Radiology, 2022, vol. 32, num.7, p. 4510-4520https://doi.org/10.1007/s00330-022-08590-0cc-by (c) Laredo, Carlos et al., 2022http://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessoai:recercat.cat:2445/2161982026-05-29T05:05:01Z
dc.title.none.fl_str_mv Clinical and therapeutic variables may influence the association between infarct core predicted by CT perfusion and clinical outcome in acute stroke
title Clinical and therapeutic variables may influence the association between infarct core predicted by CT perfusion and clinical outcome in acute stroke
spellingShingle Clinical and therapeutic variables may influence the association between infarct core predicted by CT perfusion and clinical outcome in acute stroke
Laredo Gregorio, Carlos
Isquèmia cerebral
Trombosi
Malalties cerebrovasculars
Circulació cerebral
Cerebral ischemia
Thrombosis
Cerebrovascular disease
Cerebral circulation
title_short Clinical and therapeutic variables may influence the association between infarct core predicted by CT perfusion and clinical outcome in acute stroke
title_full Clinical and therapeutic variables may influence the association between infarct core predicted by CT perfusion and clinical outcome in acute stroke
title_fullStr Clinical and therapeutic variables may influence the association between infarct core predicted by CT perfusion and clinical outcome in acute stroke
title_full_unstemmed Clinical and therapeutic variables may influence the association between infarct core predicted by CT perfusion and clinical outcome in acute stroke
title_sort Clinical and therapeutic variables may influence the association between infarct core predicted by CT perfusion and clinical outcome in acute stroke
dc.creator.none.fl_str_mv Laredo Gregorio, Carlos
Solanes, Aleix
Renú, Arturo
Rudilosso, Salvatore
Llull Estrany, Laura
López Rueda, Antonio
Macías, Napoleón G.
Rodriguez, Alejandro
Urra, Xabier
Obach, Víctor
Pariente, Jose Carlos
Chamorro Sánchez, Ángel
Radua, Joaquim
Amaro Delgado, Sergio
author Laredo Gregorio, Carlos
author_facet Laredo Gregorio, Carlos
Solanes, Aleix
Renú, Arturo
Rudilosso, Salvatore
Llull Estrany, Laura
López Rueda, Antonio
Macías, Napoleón G.
Rodriguez, Alejandro
Urra, Xabier
Obach, Víctor
Pariente, Jose Carlos
Chamorro Sánchez, Ángel
Radua, Joaquim
Amaro Delgado, Sergio
author_role author
author2 Solanes, Aleix
Renú, Arturo
Rudilosso, Salvatore
Llull Estrany, Laura
López Rueda, Antonio
Macías, Napoleón G.
Rodriguez, Alejandro
Urra, Xabier
Obach, Víctor
Pariente, Jose Carlos
Chamorro Sánchez, Ángel
Radua, Joaquim
Amaro Delgado, Sergio
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Isquèmia cerebral
Trombosi
Malalties cerebrovasculars
Circulació cerebral
Cerebral ischemia
Thrombosis
Cerebrovascular disease
Cerebral circulation
topic Isquèmia cerebral
Trombosi
Malalties cerebrovasculars
Circulació cerebral
Cerebral ischemia
Thrombosis
Cerebrovascular disease
Cerebral circulation
description Objectives: After an acute ischemic stroke, patients with a large CT perfusion (CTP) predicted infarct core (pIC) have poor clinical outcome. However, previous research suggests that this relationship may be relevant for subgroups of patients determined by pretreatment and treatment-related variables while negligible for others. We aimed to identify these variables. Methods: We included a cohort of 828 patients with acute proximal carotid arterial occlusions imaged with a whole-brain CTP within 8 h from stroke onset. pIC was computed on CTP Maps (cerebral blood flow < 30%), and poor clinical outcome was defined as a 90-day modified Rankin Scale score > 2. Potential mediators of the association between pIC and clinical outcome were evaluated through first-order and advanced interaction analyses in the derivation cohort (n = 654) for obtaining a prediction model. The derived model was further validated in an independent cohort (n = 174). Results: The volume of pIC was significantly associated with poor clinical outcome (OR = 2.19, 95% CI = 1.73 - 2.78, p < 0.001). The strength of this association depended on baseline National Institute of Health Stroke Scale, glucose levels, the use of thrombectomy, and the interaction of age with thrombectomy. The model combining these variables showed good discrimination for predicting clinical outcome in both the derivation cohort and validation cohorts (area under the receiver operating characteristic curve 0.780 (95% CI = 0.746-0.815) and 0.782 (95% CI = 0.715-0.850), respectively). Conclusions: In patients imaged within 8 h from stroke onset, the association between pIC and clinical outcome is significantly modified by baseline and therapeutic variables. These variables deserve consideration when evaluating the prognostic relevance of pIC. Key points: •The volume of CT perfusion (CTP) predicted infarct core (pIC) is associated with poor clinical outcome in acute ischemic stroke imaged within 8 h of onset. •The relationship between pIC and clinical outcome may be modified by baseline clinical severity, glucose levels, thrombectomy use, and the interaction of age with thrombectomy. •CTP pIC should be evaluated in an individual basis for predicting clinical outcome in patients imaged within 8 h from stroke onset.
publishDate 2022
dc.date.none.fl_str_mv 2022
2024
2024
2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/216198
url https://hdl.handle.net/2445/216198
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1007/s00330-022-08590-0
European Radiology, 2022, vol. 32, num.7, p. 4510-4520
https://doi.org/10.1007/s00330-022-08590-0
dc.rights.none.fl_str_mv cc-by (c) Laredo, Carlos et al., 2022
http://creativecommons.org/licenses/by/4.0
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Laredo, Carlos et al., 2022
http://creativecommons.org/licenses/by/4.0
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 10 p.
application/pdf
dc.publisher.none.fl_str_mv Springer Verlag
publisher.none.fl_str_mv Springer Verlag
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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