title: Final infarct volume is a stronger predictor of outcome than recanalization in patients with proximal middle cerebral artery occlusion treated with endovascular therapy.
abstract: OBJECTIVE
  The rationale for recanalization therapy in acute ischemic stroke is to preserve brain through penumbral salvage and thus improve clinical outcomes. We sought to determine the relationship between recanalization, clinical outcomes, and final infarct volumes in acute ischemic stroke patients presenting with middle cerebral artery occlusion who underwent endovascular therapy and post-procedure magnetic resonance imaging.
  
  
  METHODS
  We identified 201 patients with middle cerebral artery occlusion. Patients with other occlusive lesions were excluded. Baseline clinical/radiological characteristics, procedural outcomes (including thrombolysis in cerebral infarction scores), clinical outcome scores (modified Rankin scores), and final infarct volumes on diffusion weighted imaging were retrospectively analyzed from a prospectively collected database. Favorable outcome is defined as 90-day modified Rankin score≤2.
  
  
  RESULTS
  Successful recanalization (thrombolysis in cerebral infarction grade 2b or 3) was achieved in 63.2% and favorable outcomes in 46% of cases. Mean infarct volume was 50.1 mL in recanalized versus 133.9 mL in non-recanalized patients (P<0.01) and 40.4 mL in patients with favorable outcomes versus 111.8 in patients with unfavorable outcomes (P<0.01). In multivariate analysis, thrombolysis in cerebral infarction≥2b, baseline National Institute of Health Stroke Scale, Alberta Stroke Program Early Computed Tomography scores, and age were identified as independent predictors of outcome. However, when infarct volumes were included in the analysis only final infarct volume and age remained significantly associated.
  
  
  CONCLUSIONS
  Successful recanalization leads to improved functional outcomes through a reduction in final infarct volumes. In our series, age and final infarct volume but not recanalization were found to be independent predictors of outcome, supporting the use of final infarct volume as surrogate marker of outcome in acute stroke trials.
authors.affiliation: University of Toledo Medical Center, Department of Neurology, Toledo, OH, USA.
authors.forename: Syed F
authors.initials: SF
authors.lastname: Zaidi
authors.forename: Amin
authors.initials: A
authors.lastname: Aghaebrahim
authors.forename: Xabier
authors.initials: X
authors.lastname: Urra
authors.forename: Mouhammad A
authors.initials: MA
authors.lastname: Jumaa
authors.forename: Brian
authors.initials: B
authors.lastname: Jankowitz
authors.forename: Maxim
authors.initials: M
authors.lastname: Hammer
authors.forename: Raul
authors.initials: R
authors.lastname: Nogueira
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.forename: Vivek
authors.initials: V
authors.lastname: Reddy
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology / Q000628:therapy; D002548:Cerebral Revascularization; D016208:Databases, Factual; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology* / Q000628:therapy*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D061185:Mechanical Thrombolysis; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome