19 Oct 20. Featured Paper
Brain imaging abnormalities & outcome after acute ischaemic stroke: the ENCHANTED trial
Candice Delcourt, Xia Wang, Zien Zhou, Joanna M Wardlaw, Grant Mair, Thompson G Robinson, Xiaoying Chen, Sohei Yoshimura, Takako Torii-Yoshimura, Cheryl Carcel, Zeljka Calic, Wee Yong Tan, Alejandra Malavera, Craig S Anderson, Richard I Lindley
Objective: To test the hypothesis that imaging signs of ‘brain frailty’ & acute ischaemia predict clinical outcomes & symptomatic intracranial haemorrhage (sICH) after thrombolysis for acute ischaemic stroke (AIS) in the alteplase dose arm of ENhanced Control of Hypertension ANd Thrombolysis strokE stuDy (ENCHANTED).
Methods: Blinded assessors coded baseline images for acute ischaemic signs (presence, extent, swelling & attenuation of acute lesions; & hyperattenuated arteries) & pre-existing changes (atrophy, leucoaraiosis & old ischaemic lesions).
Logistic regression models assessed associations between imaging features & death at 7 & 90 days; good recovery (modified Rankin Scale scores 0–2 at 90 days) & sICH.
Data are reported with adjusted ORs & 95% CIs.
Results: 2916 patients (67±13 years, National Institutes of Health Stroke Scale 8 (5–14)) were included.
Visible ischaemic lesions, severe hypoattenuation, large ischaemic lesion, swelling & hyperattenuated arteries were associated with 7-day death (OR (95% CI): 1.52 (1.06 to 2.18); 1.51 (1.01 to 2.18); 2.67 (1.52 to 4.71); 1.49 (1.03 to 2.14) & 2.17 (1.48 to 3.18)) & inversely with good outcome.
Severe atrophy was inversely associated with 7-day death (0.52 (0.29 to 0.96)).
Atrophy (1.52 (1.08 to 2.15)) & severe leucoaraiosis (1.74 (1.20 to 2.54)) were associated with 90-day death.
Hyperattenuated arteries were associated with sICH (1.71 (1.01 to 2.89)).
No imaging features modified the effect of alteplase dose.
However, these imaging features showed no interaction with alteplase dose.
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Featured paper: Brain imaging abnormalities & outcome after acute ischaemic stroke: the ENCHANTED trial @EdinUniBrainSci #stroke #imaging