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TOPLINE:

A secondary analysis of the MR CLEAN-LATE trial found that penumbra volumes significantly modified the effectiveness of endovascular treatment (EVT) in patients with stroke in the late window, with greater benefits observed in those with larger penumbra volumes (≥ 120 mL).

METHODOLOGY:

• This study was a post hoc secondary analysis of the MR CLEAN-LATE trial and included patients with anterior circulation large vessel occlusion and collateral flow observed on CT angiography in the late window after stroke (6-24 hours after stroke symptom onset or time last seen well).
• A total of 313 participants (median age, 73 years; 50% men) were randomly assigned to receive either EVT and best medical management (n = 145) or best medical management alone (n = 168).
• The functional outcome was measured at 90 days using the modified Rankin Scale (mRS) score.
• Researchers examined treatment effectiveness in subgroups on the basis of core volumes, penumbra volumes, and mismatch ratios, with adjustments for prognostic factors including age, prestroke mRS score, and baseline National Institutes of Health Stroke Scale score.

TAKEAWAY:

• The treatment effect varied significantly by penumbra volume (P < .001 for interaction), showing the greatest benefit in patients with penumbra volumes ≥ 120 mL (adjusted common odds ratio [ACOR], 6.89; 95% CI, 2.96-16.04) and the least benefit in those with penumbra volumes ≤ 72 mL (ACOR, 0.49; 95% CI, 0.22-1.08).
• Core volumes and mismatch ratios did not alter the effect of EVT on functional outcomes at 90 days.
• Larger core volumes were associated with an increased risk for clinical stroke progression (adjusted OR per 10 mL, 1.16; 95% CI, 1.01-1.33) and an increase in infarct volume.
• Mismatch ratios were inversely associated with infarct volume.

IN PRACTICE:

"This study suggests that after selection based on collateral flow, core volume and mismatch ratio did not seem to have additional value in patient selection; penumbra size, however, modified the association of endovascular treatment with outcomes, with a trend toward potential harm in patients with the smallest penumbras," the authors wrote.

SOURCE:

This study was led by Susanne G.H. Olthuis, MD, Maastricht University Medical Centre+, Maastricht, the Netherlands. It was published online on May 5 in JAMA Neurology.

LIMITATIONS:

This analysis was exploratory and not powered for CT perfusion (CTP)–specific outcomes. CTP data were available for only 62% of patients, potentially introducing bias due to missing data. Additionally, the findings were not generalisable to rural or unselected patient populations.

DISCLOSURES:

The MR CLEAN-LATE trial was funded by the Collaboration for New Treatments of Acute Stroke Consortium, supported by the Netherlands Cardiovascular Research Initiative and the Netherlands Brain Foundation. The collaboration project received additional financing from the Ministry of Economic Affairs. Unrestricted funding was provided by Stryker, Medtronic, and Cerenovus. Several authors reported receiving institutional grants or personal fees from industry and non-profit funders, with one disclosing a minority stake in Nicolab. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.