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American Heart Association

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Final ID: 74

ADC-based Infarct Density – Validating a Novel Imaging Biomarker of Functional Outcome after Endovascular Thrombectomy

Abstract Body: Introduction: Endovascular thrombectomy (EVT) dramatically improves clinical outcomes, but the reduction in final infarct volume only accounts for a minority of the treatment effect. There is a need for surrogate imaging biomarkers that more strongly associate with functional outcome, to refine prognostication and facilitate development of EVT-adjuvant neuroprotective therapies. Our group recently developed a straightforward ADC-based metric of post-EVT infarct density (i.e. a measure of infarct severity). We aimed to validate this novel metric in a multicenter study of EVT patients.
Methods: A retrospective cohort included consecutive patients with anterior circulation LVO who underwent EVT at two stroke centers. MRI was performed 12–48 hours post-EVT. Good functional outcome was defined as a 90-day modified Rankin Scale score ≤2. MR imaging was processed via RAPID, and final infarct volume was based on the standard ADC <620 threshold. Lesion volume was also assessed using ADC <470, and infarct density was calculated as the percentage of final infarct volume with ADC <470 (Figure 1). Multivariate logistic regression quantified the associations between clinical/imaging variables and functional outcome. Model performance was quantified by ROC analysis and compared to a model consisting solely of clinical variables and a model consisting of clinical variables and infarct volume.
Results: Of 312 patients, 284 (92%) achieved successful recanalization (mTICI ≥2b), and 54% achieved a good outcome. The mean age was 69 years (+/- 14); 41% were female. The mean final infarct volume was 50mL (+/- 73). Infarct density was significantly lower in patients with a good outcome (8.3% vs 30.3%, p<0.0001). Table 1 reports the univariate and multivariate analyses. Infarct density was robustly associated with outcome after adjustment for other significant factors including infarct volume (aOR: 0.954 per 1% increase in infarct density). Figure 2 compares the AUC of the three prespecified models, and the best classification was achieved by including infarct density (AUC 0.87; 95%CI: 0.83-0.91).
Conclusion: Infarct density after EVT is independently associated with long term clinical outcome and provides greater prognostic value than final infarct volume alone. Derived from routinely acquired MRI, infarct density is a potentially useful and easily calculable surrogate outcome measure that can be used in clinical trials of EVT-adjuvant therapies.
  • Favilla, Christopher  ( University of Pennsylvania , Philadelphia , Pennsylvania , United States )
  • Bonkhoff, Anna  ( Massachusetts General Hospital , Watertown , Massachusetts , United States )
  • Rost, Natalia  ( MASSACHUSETTS GENERAL HOSPITAL , Winchester , United States Minor Outlying Islands )
  • Messe, Steven  ( University of Pennsylvania , Philadelphia , Pennsylvania , United States )
  • Regenhardt, Robert  ( Massachusetts General Hospital , Watertown , Massachusetts , United States )
  • Denny, Braden  ( University of Pennsylvania , Philadelphia , Pennsylvania , United States )
  • Simonsen, Claus  ( Aarhus University Hospital , Aarhus , Denmark )
  • Shakibajahromi, Banafsheh  ( University of Pennsylvania , Philadelphia , Pennsylvania , United States )
  • Patel, Aman  ( Massachusetts General Hospital , Watertown , Massachusetts , United States )
  • Leslie-mazwi, Thabele  ( University of Washington , Seattle , Washington , United States )
  • Dmytriw, Adam  ( Massachusetts General Hospital , Watertown , Massachusetts , United States )
  • Schirmer, Markus  ( HMS MGH , Boston , Massachusetts , United States )
  • Author Disclosures:
    Christopher Favilla: DO have relevant financial relationships ; Research Funding (PI or named investigator):Openwater:Past (completed) | Anna Bonkhoff: DO NOT have relevant financial relationships | Natalia Rost: DO NOT have relevant financial relationships | Steven Messe: DO NOT have relevant financial relationships | Robert Regenhardt: DO have relevant financial relationships ; Other (please indicate in the box next to the company name):Rapid Medical (DSMB):Active (exists now) ; Research Funding (PI or named investigator):SVIN:Past (completed) ; Research Funding (PI or named investigator):Heitman Foundation for Stroke:Active (exists now) ; Research Funding (PI or named investigator):NINDS:Past (completed) | Braden Denny: DO NOT have relevant financial relationships | Claus Simonsen: DO NOT have relevant financial relationships | Banafsheh Shakibajahromi: DO NOT have relevant financial relationships | Aman Patel: DO have relevant financial relationships ; Consultant:microvention :Active (exists now) ; Consultant:medtronic:Active (exists now) ; Consultant:Stryker:Active (exists now) | Thabele Leslie-Mazwi: DO NOT have relevant financial relationships | Adam Dmytriw: DO NOT have relevant financial relationships | Markus Schirmer: DO have relevant financial relationships ; Research Funding (PI or named investigator):NIA:Active (exists now) ; Research Funding (PI or named investigator):MIT/MGB:Active (exists now) ; Research Funding (PI or named investigator):Heinz Fdt:Active (exists now) ; Research Funding (PI or named investigator):Heitman Fdt:Active (exists now)
Meeting Info:
Session Info:

Neuroendovascular Oral Abstracts II

Wednesday, 02/05/2025 , 04:45PM - 05:45PM

Oral Abstract Session

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