Factors Associated with Discrepancy Between Post-treatment Infarct Volume and 90-day Functional Outcome in the ESCAPE Randomized Controlled Trial (S47.008)

Objective: To explore factors associated with discrepancies between functional ability and post-treatment infarct volume (PIV) in the ESCAPE trial. Background: Endovascular thrombectomy (EVT) likely improves functional ability in patients with acute ischemic stroke by saving at-risk brain tissue. However, some patients with small infarct volume after EVT have poor outcomes whilst others with large infarcts sometimes fare well. Design/Methods: We identified patients with small PIV≤25th percentile and large PIV≥75th percentile on 24–48-hour CT/MRI. Demographics, comorbidities, baseline stroke severity measured using NIHSS, stroke location, treatment type, post-stroke complications, 24-/48-hour severity (NIHSS), and other post-EVT outcome scales like the Barthel Index and EQ-5D were compared between “discrepant cases” – those with 90-day modified Rankin Scale (mRS)≤2 (good functional ability) despite large PIV or mRS>2 despite small PIV – and “non-discrepant cases”. Multi-variable logistic regression was used to identify pre-treatment and post-treatment factors associated with small-PIV/mRS>2 and large-PIV/mRS≤2. Results: Among 315 patients, median PIV was 21mL. 27/79(34.2%) patients with PIV≤7mL (25th percentile) had mRS>2, and 12/80(15.0%) with PIV≥72mL (75th percentile) had mRS≤2. Discrepant cases did not differ significantly in CT versus MRI-based PIV ascertainment (p=0.39). Pre-treatment factors independently associated with small-PIV/mRS>2 included older age(p=0.028), cancer, vascular risk-factors (perfect predictors), and lower hemoglobin(p=0.043); post-treatment factors included 48-hour NIHSS(p=0.007) and post-stroke complications(p=0.026). Younger age(p Conclusions: Discrepancies between functional ability and PIV are likely explained by differences in pre-treatment factors like age and comorbidities, and post-treatment factors like the 48-hour NIHSS (likely reflecting functional eloquence) and post-stroke complications. Post-stroke complications were the only modifiable post-treatment factor consistently associated with discrepant outcomes, suggesting that high-quality post-acute care, aimed at preventing complications, may help optimize outcomes in patients receiving EVT. Disclosure: Dr. Ganesh has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Adkins Research Group. Dr. Ganesh has received compensation for serving on the Board of Directors of SnapDx, and AHA Health Ltd. Dr. Menon has nothing to disclose. Dr. Assis has nothing to disclose. Dr. Demchuk has nothing to disclose. Dr. Al-Ajlan has nothing to disclose. Dr. Almekhlafi has nothing to disclose. Dr. Rempel has nothing to disclose. Dr. Baxter has nothing to disclose. Dr. Thornton has nothing to disclose. Dr. Kashani has nothing to disclose. Dr. Hill has nothing to disclose. Dr. Goyal has nothing to disclose. Dr. Goyal has nothing to disclose.