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Ischemic stroke
Original research
Neurological outcomes for patients meeting radiographic criteria for DEFUSE 3 and SELECT2
  1. Rahul R Karamchandani1,
  2. Sagar Satyanarayana2,
  3. Hongmei Yang2,
  4. Dale Strong2,
  5. Jeremy Rhoten1,
  6. Jonathan Clemente3,4,
  7. Gary Defilipp3,4,
  8. Nikhil M Patel5,
  9. Joe Bernard6,7,
  10. William Stetler6,7,
  11. Jonathan M Parish6,7,
  12. Gregory W Albers8,
  13. Jeremy J Heit9,
  14. Amy K Guzik10,
  15. Stacey Q Wolfe11,
  16. Andrew Hines3,12,
  17. Harsh N Patel7,
  18. Anna Maria Helms1,
  19. Lauren Macko1,
  20. Laura Williams1,
  21. Julia Retelski1,
  22. Andrew W Asimos13
  1. 1Department of Neurology, Neurosciences Institute, Atrium Health, Charlotte, North Carolina, USA
  2. 2Information and Analytics Services, Atrium Health, Charlotte, North Carolina, USA
  3. 3Department of Radiology, Charlotte Radiology, Charlotte, North Carolina, USA
  4. 4Department of Radiology, Neurosciences Institute, Atrium Health, Charlotte, North Carolina, USA
  5. 5Department of Internal Medicine, Pulmonary and Critical Care; Neurosciences Institute, Atrium Health, Charlotte, North Carolina, USA
  6. 6Department of Neurosurgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina, USA
  7. 7Department of Neurosurgery, Neurosciences Institute, Atrium Health, Charlotte, North Carolina, USA
  8. 8Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
  9. 9Department of Radiology and Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
  10. 10Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  11. 11Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  12. 12Department of Radiology, Neurosciences Institute, Atrium Health, Concord, North Carolina, USA
  13. 13Department of Emergency Medicine, Neurosciences Institute, Atrium Health, Charlotte, North Carolina, USA
  1. Correspondence to Dr Rahul R Karamchandani; rahul.karamchandani{at}gmail.com

Abstract

Background The DEFUSE 3 and SELECT2 thrombectomy trials included some patients with similar radiographic profiles, although the rates of good functional outcomes differed widely between the studies.

Objective To report neurological outcomes for patients who meet CT and CT perfusion (CTP) inclusion criteria common to both DEFUSE 3 and SELECT2.

Methods Retrospective study of thrombectomy patients, presenting between November 2016 and December 2023 to a large health system, with Alberta Stroke Program Early CT score ≥6, core infarction 50–69 mL, mismatch ratio ≥1.8, and mismatch volume ≥15 mL. The primary outcome was 90-day modified Rankin Scale score 0–2. A logistic regression analysis was performed to identify independent predictors of the primary outcome.

Results 85 patients, with mean age 64.6 (16.6) years and median National Institutes of Health Stroke Scale score 18 (15–23), were included. Thirty-eight of 85 patients (44.7%) were functionally independent at 90 days. Predictors of functional independence included age (OR=0.943, 95% CI 0.908 to 0.980; P=0.003), initial glucose (OR=0.989, 95% CI 0.978 to 1.000; P=0.044), and time last known well to skin puncture (OR=0.997, 95% CI 0.994 to 1.000; P=0.028). The area under the curve for the multivariable model predicting the primary outcome was 0.82 (95% CI 0.73 to 0.92).

Conclusion Nearly half of patients meeting radiographic criteria common to DEFUSE 3 and SELECT2 are functionally independent at 90 days, similar to rates reported for the treated DEFUSE 3 cohort. This might be due to their moderate core volumes and large ischemic penumbra.

  • CT perfusion
  • Stroke
  • Thrombectomy
  • CT Angiography

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2024-021976

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @JeremyHeitMDPHD

    • Contributors All authors meet authorship guidelines provided by the International Committee of Medical Journal Editors. RRK (guarantor) – study design, data collection, data analysis interpretation, initial manuscript drafting, critical manuscript review. SS – study design, data analysis, data analysis interpretation, critical manuscript review. HY – study design, data analysis, data analysis interpretation, critical manuscript review. DS – study design, data collection, data analysis, data analysis interpretation, critical manuscript review. JR – study design, data collection, data analysis, data analysis interpretation, critical manuscript review. JC – data collection, data analysis interpretation, critical manuscript review. GD – data collection, data analysis interpretation, critical manuscript review. NMP – study design, data analysis interpretation, critical manuscript review. JB – data collection, data analysis interpretation, critical manuscript review. WS – data collection, data analysis interpretation, critical manuscript review. JMP – data collection, data analysis interpretation, critical manuscript review. GWA – data analysis interpretation, critical manuscript review. JJH -- data analysis interpretation, critical manuscript review. AKG – data analysis interpretation, critical manuscript review. SQW – data analysis interpretation, critical manuscript review. AH – data analysis interpretation, critical manuscript review. HNP -- data analysis interpretation, critical manuscript review. AMH – data collection, data analysis interpretation, critical manuscript review. LM – data analysis interpretation, critical manuscript review. LW - data collection, data analysis interpretation, critical manuscript review. JR – data analysis interpretation, critical manuscript review. AWA – study design, data analysis interpretation, critical manuscript review, project supervision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JB declares stock/stock options from Viz.Ai and personal fees from Stryker, Terumo, and Rapid AI. JJH is a consultant for Medtronic and MicroVention and a member of the Scientific and Advisory Board for iSchemaView; reports an equity interest in Dragon Medical, Inc. GWA is a consultant for Genentech and iSchemaView, and has equity interest in iSchemaView. AWA is a consultant for iSchemaView. All other authors report no disclosures.

    • Provenance and peer review Not commissioned; externally peer reviewed.