Trial reportEuropean radiology2019
Follow-up infarct volume as a mediator of endovascular treatment effect on functional outcome in ischaemic stroke.
Trial report in European radiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
15 citing papers in PubMed.
- Effect of Endovascular Thrombectomy for Acute Ischemic Stroke on Cognitive Outcomes: A Secondary Analysis of the ESCAPE Trial.Neurology · 2024Trial
- Trial
- Successful reperfusion for better outcomes in medium vessel occlusion: Penumbral salvage versus infarct volume reduction.European stroke journal · 2026Observational
- Successful reperfusion for better outcomes in medium vessel occlusion: Penumbral salvage versus infarct volume reduction.European stroke journal · 2025Article
- Infarct density defined by ADC threshold is associated with long-term functional outcome after endovascular thrombectomy.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2024Article
- Introducing the Futile Recanalization Prediction Score (FRPS): A Novel Approach to Predict and Mitigate Ineffective Recanalization after Endovascular Treatment of Acute Ischemic Stroke.Neurology international · 2024Article
- Review
- Duration of Ischemia Affects Outcomes Independent of Infarct Size in Stroke.Stroke (Hoboken, N.J.) · 2022Article
- Influence of cerebral microbleeds on mechanical thrombectomy outcomes.Scientific reports · 2022Article
- A porous circulation model of the human brain forInterface focus · 2021Article
- The Natural History and Reperfusion Therapy Outcomes of Acute Ischemic Stroke due to Isolated M2 Occlusions.BioMed research international · 2021Article
- Exploring mechanisms of action in clinical trials of complex surgical interventions using mediation analysis.Clinical trials (London, England) · 2020Article
- Article
- Mediation of the Relationship Between Endovascular Therapy and Functional Outcome by Follow-up Infarct Volume in Patients With Acute Ischemic Stroke.JAMA neurology · 2019Article
- Neuropsychological deficits in patients with favorable outcomes after middle cerebral artery infarction treated with thrombectomy.Frontiers in neurologyArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe putative mechanism for the favourable effect of endovascular treatment (EVT) on functional outcome after acute ischaemic stroke is preventing follow-up infarct volume (FIV) progression. We aimed to assess to what extent difference in FIV explains the effect of EVT on functional outcome in a randomised trial of EVT versus no EVT (MR CLEAN).
methodsFIV was assessed on non-contrast CT scan 5-7 days after stroke. Functional outcome was the score on the modified Rankin Scale at 3 months. We tested the causal pathway from intervention, via FIV to functional outcome with a mediation model, using linear and ordinal regression, adjusted for relevant baseline covariates, including stroke severity. Explained effect was assessed by taking the ratio of the log odds ratios of treatment with and without adjustment for FIV.
resultsOf the 500 patients included in MR CLEAN, 60 died and four patients underwent hemicraniectomy before FIV was assessed, leaving 436 patients for analysis. Patients in the intervention group had better functional outcomes (adjusted common odds ratio (acOR) 2.30 (95% CI 1.62-3.26) than controls and smaller FIV (median 53 vs. 81 ml) (difference 28 ml; 95% CI 13-41). Smaller FIV was associated with better outcome (acOR per 10 ml 0.60, 95% CI 0.52-0.68). After adjustment for FIV the effect of intervention on functional outcome decreased but remained substantial (acOR 2.05, 95% CI 1.44-2.91). This implies that preventing FIV progression explains 14% (95% CI 0-34) of the beneficial effect of EVT on outcome.
conclusionThe effect of EVT on FIV explains only part of the treatment effect on functional outcome. KEY POINTS: • Endovascular treatment in acute ischaemic stroke patients prevents progression of follow-up infarct volume on non-contrast CT at 5-7 days. • Follow-up infarct volume was related to functional outcome, but only explained a modest part of the effect of intervention on functional outcome. • A large proportion of treatment effect on functional outcome remains unexplained, suggesting FIV alone cannot be used as an early surrogate imaging marker of functional outcome.
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