Article Figures & Data
Figures
- Figure 1
Flow chart. Excellent outcome was defined as a 3-month modified Rankin Scale (mRS) score ≤1. *One of the requirements for mechanical thrombectomy was the absence of neurological improvement ≥4 points between baseline National Institutes of Health Stroke Scale (NIHSS) and NIHSS within 1 hour of IVT. ICA, internal carotid artery occlusion; IVT, intravenous thrombolysis; MT, mechanical thrombectomy; THRACE, Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke.
Tables
- Table 1
Cohort description and bivariate analysis
All
(n=247)3-month mRS score 0–1
(n=77)3-month mRS score 2–6
(n=170)P value Sociodemographic features Age, n 247/247 77/77 170/170 0.36* Mean (SD), years 63.8 (13.9) 62.5 (14.2) 64.3 (13.8) Median (IQR), years 68.0 (20.0) 66.0 (22.0) 68.5 (18.0) Sex, n Female, n (%) 121/247 44/77 77/170 0.084† Comorbidities and risk factors, n Diabetes 37/242 8/76 29/166 0.16† Hypertension 137/244 35/77 102/167 0.022† Hypercholesterolaemia 125/220 40/72 85/148 0.79† Renal insufficiency 11/242 1/75 10/167 0.18‡ History of stroke 17/241 5/77 12/164 1.00‡ Coronaropathy 41/233 11/76 30/160 0.38† Peripheral arterial disease 9/226 2/75 7/151 0.72‡ Current smoking 53/221 12/75 41/146 0.046† Baseline clinical status NIHSS score, n 245/247 77/77 168/170 Mean (SD), pts 16.9 (4.3) 15.6 (4.1) 17.5 (4.2) 0.0013* Median (IQR), pts 17.0 (7.0) 15.0 (7.0) 18.0 (7.0) Blood pressure, n 244/247 77/77 167/170 SBP, mean (SD), mm Hg 144 (23) 144 (22) 144 (23) 0.87* DBP, mean (SD), mm Hg 79 (16) 77 (13) 80 (17) 0.26* Heart rate, n 242/247 76/77 166/170 Mean (SD), bpm 75 (17) 75 (16) 76 (17) 0.81* Glycaemia, n 239/247 75/77 164/170 Mean (SD), g/L 1.24 (0.38) 1.16 (0.26) 1.27 (0.42) 0.0099* Temperature, n 237/247 73/77 164/170 Mean (SD), °C 36.6 (0.5) 36.7 (0.6) 36.6 (0.5) 0.48* Weight, n 243/247 77/77 166/174 Mean (SD), kg 75.7 (15.7) 76.3 (14.4) 75.4 (16.3) 0.68* Baseline imaging characteristics Imaging techniques, n CT 58/247 14/77 44/170 0.19§ MRI 189/247 63/77 126/170 Ischaemic core ASPECTS score, n 243/247 76/77 167/170 Mean (SD), pts 7.1 (2.3) 7.8 (1.8) 6.8 (2.5) 0.010§ DWI volume, n 184/189 62/63 122/126 Mean (SD), mL 40.2 (52.7) 17.0 (16.7) 52.0 (60.3) 0.0003§ Median (IQR), mL 14.8 (44.7) 10.5 (14.0) 19.1 (71.8) Vascular territory of ischaemia, n Superficial and deep MCA territory 126/237 28/75 98/162 0.0031‡ Superficial MCA 26/237 12/75 14/162 Deep MCA 78/237 33/75 45/162 ACA 4/237 0/75 4/162 Anterior choroid artery 3/237 2/75 1/162 Microvascular leukopathy Fazekas score of DWM, n Absence 73/183 30/61 43/122 0.24‡ Punctuate foci 65/183 20/61 45/122 Beginning confluence 29/183 6/61 23/122 Large confluent areas 16/183 5/61 11/122 Thrombus Occlusion site, n C1 39/240 4/76 35/164 0.0017†¶ M1 199/240 71/76 128/164 M2 2/240 1/76 1/164 HMCAS/SVS, n Presence versus absence, n 176/234 55/75 121/159 0.65† Length, mean (SD), mm 14.3 (10.7) 11.3 (8.3) 15.7 (11.4) 0.0008§ Clot burden score, mean (SD), pts 7.0 (1.8) 7.5 (1.5) 6.8 (1.9) 0.0016§ Mismatch ASPECT-FVH score, n 151/189 51/63 100/126 0.74§ Mean (SD), pts 3.6 (1.1) 3.5 (1.0) 3.6 (1.1) Median (IQR), pts 4.0 (1.0) 4.0 (1.0) 4.0 (1.0) FVH/DWI mismatch Presence versus absence, n 135/177 53/61 82/116 0.016† Care workflow time Onset-to-Imaging time, n 242/247 76/77 166/170 Mean (SD), min 116 (43) 110.6 (50.8) 119.0 (39.0) 0.20* Onset-to-thrombolysis time, n 245/247 77/77 168/170 Mean (SD), min 153 (40) 142.2 (37.4) 158.0 (41.0) 0.0042* MRI-to-thrombolysis time, n 241/247 76/77 165/170 Mean (SD), min 40 (20) 39.4 (20.6) 40.1 (19.4) 0.81* 24-hour clinical and radiological features NIHSS score, n 230/247 76/77 154/170 Mean (SD), pts 11.6 (8.2) 3.7 (3.5) 15.5 (7.0) <0.0001§ Median (IQR) 11.0 (14.0) 3.0 (6.0) 16.0 (9.0) ASPECTS, n 235/247 74/77 161/170 Mean (SD), pts 5.9 (2.7) 7.6 (1.6) 5.1 (2.8) <0.0001§ Haemorrhagic classification (SITS-MOST), n Absence 163/236 58/74 105/162 0.27‡ Haemorrhagic infarction 1 26/236 7/74 19/162 Haemorrhagic infarction 2 26/236 5/74 21/162 Parenchymal haemorrhage 1 11/236 3/74 8/162 Parenchymal haemorrhage 2 10/236 1/74 9/162 3-month excellent outcome after IVT alone was defined as a mRS score ≤1.
*Statistical analysis was performed with the Student’s t-test.
†χ2 test.
‡Fisher’s exact test.
§Kruskal-Wallis test.
¶Comparison between C1 segment and M1/M2 segment.
ACA, anterior cerebral artery; ASPECT-FVH score (0–6), extent of FLAIR vascular hyperintensities based on ASPECTS territories and without counting insula (higher is better); ASPECTS (0–10), Alberta Stroke Programme Early CT score (higher is better); C1, distal intracranial portion of internal carotid artery; DBP, diastolic blood pressure; DWI volume, diffusion-weighted imaging infarct volume; DWM, deep white matter; FVH/DWI mismatch, FLAIR vascular hyperintensities and diffusion-weighted imaging infarct hyperintensity mismatch; HMCAS, hyper-dense middle cerebral artery sign on CT; M1, first segment of the middle cerebral artery; M2, branches downstream of M1 segment of the middle cerebral artery; MCA, middle cerebral artery; mRS, modified Rankin Scale; NIHSS score (0–42), National Institutes of Health Stroke Scale score; pts, patients; SBP, systolic blood pressure; SITS-MOST, Safe Implementation of Thrombolysis in Stroke MOnitoring STudY; SVS, susceptibility vessel sign on MRI; clot burden score (0–10): higher is better.
- Table 2
Predictors of 3-month excellent outcome after IVT
3-month mRS score 0–1
(n=77/247)Bivariate (n=247) Multivariate (n=247) OR 95% CI P value OR 95% CI P value Sociodemographics features Age 0.99 0.97 to 1.01 0.36 Sex: male versus female 0.62 0.36 to 1.07 0.09 Comorbidities and risk factors Hypertension: absence versus presence 1.87 1.42 to 2.47 0.024 2.43 1.74 to 3.38 0.0074 Diabetes: absence versus presence 1.83 0.80 to 4.22 0.15 Current smoking: absence versus presence 1.86 1.30 to 2.66 0.083 2.76 1.79 to 4.26 0.019 Baseline clinical examination NIHSS score, pts* 0.90 0.84 to 0.96 0.0018 Systolic blood pressure, mm Hg* 1.00 0.99 to 1.01 0.91 Glycaemia, g/L* 0.39 0.17 to 0.92 0.031 Temperature, °C* 1.23 0.74 to 2.05 0.43 OTT Hour* 0.53 0.35 to 0.83 0.0048 0.47 0.23 to 0.78 0.0033 Imaging features Imaging technique: CT versus MRI 0.64 0.32 to 1.25 0.19 DWI volume, 10 mL†‡ 0.85 0.77 to 0.94 0.0016 0.78 0.68 to 0.89 0.0004 Infarct territory 0.0033 Superficial MCA Reference Deep MCA 0.86 0.35 to 2.08 0.73 Superficial and deep MCA 0.34 0.14 to 0.81 0.015 Other 0.41 0.07 to 2.23 0.30 Thrombus length‡ HMCAS length, mm* 0.95 0.91 to 1.00 0.030 0.98 0.92 to 1.03 0.37 SVS length, mm* 0.96 0.93 to 0.99 0.017 0.87 0.80 to 0.94 0.0012 Occlusion site: M1 versus C1 4.66 1.61 to 13.52 0.0046 Clot burden score‡ CT, pts* 1.23 1.00 to 1.50 0.046 MRI, pts* 1.26 1.07 to 1.47 0.0053 HMCAS/SVS HMCAS: presence versus absence 0.87 0.25 to 2.99 0.83 0.80 0.22 to 2.99 0.74 SVS: presence versus absence 0.84 0.40 to 1.77 0.65 7.89 1.65 to 37.78 0.0097 FVH/DWI mismatch: yes versus no‡ 2.71 1.19 to 6.20 0.018 ASPECT-FVH score, pts*‡ 1.09 0.93 to 1.27 0.31 DWM Fazekas score, pts‡ CT, pts* 0.68 <0.01 to >100 0.99 MRI, pts* 0.79 0.56 to 1.10 0.16 3-month excellent outcome after IVT defined by a 3-month mRS score ≤1.
All ORs are calculated for 3-month mRS score ≤2.
Bold values shows p<0.05.
*ORs express the risk variation for a unit increase of the variable.
†ORs express the risk variation for 10 mL increase in the ischaemic core volume on DWI.
‡Nested effect is adjusted on the nesting characteristics, that is, imaging type, to consider effect differently in CT and in MRI.
ASPECTS-FVH score, Alberta Stroke Programme Early CT score and extent of FLAIR vascular hyperintensities (0–6); C1, distal internal carotid artery; clot burden score (0–10); DWI, diffusion-weighted imaging; DWI volume, ischaemic core volume on DWI; DWM Fazekas score, deep white matter Fazekas score (0–3); FVH/DWI mismatch, FLAIR vascular hyperintensity and DWI infarct hyperintensity mismatch; HMCAS/SVS, hyper-dense MCA sign on CT or susceptibility vessel sign on T2*-MRI; IVT, intravenous thrombolysis; M1, first segment of MCA; MCA, middle cerebral artery; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke scale; OTT, onset-to-treatment time; pts, patients.
- Table 3
Association of 24-hour neurological improvement with 3-month outcome
3-month mRS score 0–1 (n=76/230) AUC 95% CI Se Sp PPV NPV OR* 95% CI P value OR† 95% CI P value SNI: yes versus no 0.76 0.71 to 0.82 0.57 0.96 0.88 0.82 32.14 12.63 to 81.76 <0.0001 14.35 5.04 to 40.87 <0.0001 MNI: yes versus no 0.82 0.76 to 0.87 0.78 0.86 0.73 0.89 20.82 10.31 to 42.07 <0.0001 26.57 9.52 to 74.19 <0.0001 NINDS NI: yes versus no 0.80 0.76 to 0.85 0.95 0.66 0.58 0.96 35.31 12.22 to 101.99 <0.0001 29.82 8.85 to 100.51 <0.0001 ≥25% NI: yes versus no 0.81 0.77 to 0.86 0.96 0.67 0.59 0.97 49.14 14.77 to 163.54 <0.0001 35.50 9.59 to 131.38 <0.0001 ≥50% NI: yes versus no 0.85 0.80 to 0.90 0.84 0.85 0.74 0.91 30.38 14.22 to 64.91 <0.0001 20.57 8.45 to 50.05 <0.0001 Normalised change, %‡ 0.93 0.89 to 0.96 1.87 1.73 to 2.02 <0.0001 1.79 1.65 to 1.93 <0.0001 Normalised change, calculated as
and as
, if baseline NIHSS–24-hour NIHSS <0.Statistical significance requires p<0.004 after Bonferroni correction.
*All ORs and AUC were estimated without adjustment to baseline explaining variables.
†All ORs and AUC were estimated with adjustment on baseline NIHSS, age, 24-hour ASPECT score and SITS-MOST haemorrhage classification, and on factors identified in the previously prediction model.
‡OR express the risk variation for a 10% increase of the variable.
AUC, area under the receiver operating characteristic curve; MNI, major neurological improvement defined as 24-hour NIHSS score ≤1 or a 8-point improvement between baseline and 24-hour NIHSS; mRS, modified Rankin Scale (0–6); 3-month excellent outcome defined as mRS 0–1; ≥25% NI, 24-hour neurological improvement by at least 25% from baseline NIHSS; ≥50% NI, 24-hour neurological improvement by at least 50% from baseline NIHSS; NIHSS, National Institutes of Health Stroke scale; NINDS NI, National Institute of Neurological Disorders and Stroke neurological improvement defined as a 4-point improvement between baseline and 24-hour NIHSS; NPV, negative predictive value; PPV, positive predictive value; Se, sensitivity; SNI, strong neurological improvement defined as 24-hour NIHSS score ≤3; Sp, specificity.
