Factors associated with infarct volume growth after mechanical thrombectomy in large core infarction: ANGEL-ASPECT insights.

BACKGROUND

Infarct volume growth (IVG) correlates with outcomes and may represent a prognostic imaging biomarker in acute ischaemic stroke due to anterior circulation large vessel occlusion (LVO). This study aims to identify factors associated with IVG after mechanical thrombectomy (MT) in patients with large core infarction.

METHODS

This is a post hoc analysis of the Endovascular Therapy in Anterior Circulation Large Vessel Occlusion with a Large Infarct randomised trial. IVG was calculated as final infarct volume minus baseline infarct volume (BIV). The optimal IVG threshold for predicting 90-day favourable outcomes (modified Rankin Scale score 0-3) was determined using receiver operating characteristic (ROC) curve analysis, maximising both sensitivity and specificity. Factors associated with IVG were identified using multivariate logistic regression analyses.

RESULTS

Among 228 included patients, ROC analysis identified an optimal IVG threshold of 105 mL for predicting favourable 90-day outcomes (area under the curve=0.71; specificity=0.85, sensitivity=0.53). Patients were stratified into mild (IVG <105 mL, n=150) and severe (IVG ≥105 mL, n=78) groups. Multivariate logistic regression identified BIV (OR 1.02, 95% CI 1.00 to 1.03; p<0.01), admission blood glucose (OR 1.20, 95% CI 1.04 to 1.37; p=0.01), time from puncture to recanalisation (OR 1.01, 95% CI 1.00 to 1.02; p=0.049) and recanalisation at 36 hours (±12 hours) (OR 0.19, 95% CI 0.05 to 0.72; p=0.01) as independent factors associated with IVG.

CONCLUSION

IVG after MT significantly correlates with clinical outcomes. Identification of modifiable IVG determinants after MT may inform periprocedural management strategies in patients with large infarct due to LVO.

TRIAL REGISTRATION NUMBER: NCT04551664.