Final Infarct Volume as a Surrogate End Point in Anterior Circulation ICAS-LVO Stroke: Post Hoc Secondary Analysis of RESCUE-ICAS
Year: 2026
Type: article
Abstract: BACKGROUND: Final infarct volume (FIV) on 24-hour magnetic resonance imaging is a well-established imaging biomarker linked to functional recovery after ischemic stroke, yet its prognostic value in intracranial atherosclerosis–related large vessel occlusion remains poorly explored. The impact of adjunct intracranial stenting on both infarct size and progression also remains unclear in this population. This study aimed to examine the association between FIV and clinical outcome, evaluate the effect of adjunct stenting on FIV and infarct progression, and assess the relationship between infarct progression and functional independence. METHODS: We conducted a post hoc secondary analysis of the RESCUE-ICAS registry (Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis); only patients with anterior circulation large vessel occlusion with magnetic resonance imaging after thrombectomy were included. FIV was measured on diffusion-weighted magnetic resonance imaging performed 24 to 36 hours postthrombectomy. Infarct progression was defined as the difference between baseline computed tomography perfusion infarct volume (cerebral blood flow <30%) on presentation and 24- to 36-hour FIV. The primary outcome was 90-day functional independence (modified Rankin Scale score 0–2). Additional analyses evaluated the association between adjunct intracranial stenting and FIV, and the association between infarct progression and 90-day functional outcome. Associations were analyzed using multivariable logistic regression and inverse probability of treatment weighting. RESULTS: Of the 417 patients included in RESCUE-ICAS, 203 had anterior circulation intracranial atherosclerosis–related large vessel occlusion and underwent magnetic resonance imaging 24 to 36 hours postthrombectomy. Among these, 80 patients (39%) received adjunct stenting. FIV was independently associated with 90-day functional independence (adjusted odds ratio per 10 mL increase, 0.8 [95% CI, 0.68–0.94]; P =0.007). Adjunct stenting was associated with a significant relative reduction in FIV, with inverse probability of treatment weighting–adjusted analyses demonstrating a 37.8% lower FIV compared with no stenting ( β =−0.47 [95% CI, −0.93 to −0.02]; P =0.043). Among 108 patients with baseline computed tomography perfusion data, infarct progression was strongly associated with outcome, with each additional 10 mL associated with ≈25% lower odds of achieving modified Rankin Scale score 0 to 2 at 90 days (adjusted odds ratio, 0.74 [95% CI, 0.60–0.90]; P =0.004), although infarct progression did not differ significantly between stented and nonstented groups (Δ −9.53 mL [95% CI −37.9 to 18.8]; P =0.506). In inverse probability of treatment weighting–weighted models adjusted for successful recanalization, stenting was not independently associated with reduced FIV ( β =−0.41; P =0.066), but remained independently associated with higher odds of 90-day functional independence (odds ratio, 2.29 [95% CI, 1.24–4.27]; P =0.008). CONCLUSIONS: Among intracranial atherosclerosis–related large vessel occlusion patients, 24- to 36-hour FIV is a strong predictor of functional outcome. Adjunct stenting is associated with smaller FIV. Lower infarct progression was also associated with favorable outcome. These findings highlight FIV as a reliable imaging biomarker and potential surrogate end point in future trials.
Authors: Ahmad Abu Qdais, Mustafa Ismail, Ahmed Abdelwahab, Eyad Almallouhi, Shadi Yaghi, Violiza Inoa-Acosta, Francesco Capasso, Michael Nahhas, Robert M. Starke, Isabel Fragata, Matthew T. Bender, Krisztina Moldovan, Ilko Maier, Jonathan A. Grossberg, Pascal Jabbour, Marios Psychogios, Edgar A. Samaniego, Jan-Karl Burkhardt, Brian Jankowitz, Mohamad Abdalkader, Ashley Choi, Ameer E. Hassan, David Altschul, Justin Mascitelli, Robert W. Regenhardt, Stacey Wolfe, Mohamad Ezzeldin, Kaustubh Limaye, Hosam Al Jehani, Muhammad H. Niazi, Nitin Goyal, Stavropoula Tjoumakaris, Ali Alawieh, Mohammed Almekhlafi, Eytan Raz, Adam Mierzwa, Syed Zaidi, Alejandro M. Spiotta, Kimberly Kicielinski, Jonathan Lena, Zachary Hubbard, Osama O. Zaidat, Colin P. Derdeyn, Ramesh Grandhi, Thanh N. Nguyen, Adam de Havenon, Sami Al Kasab, Mouhammad Jumaa
Institutions: Medical University of South Carolina, Sarasota Memorial Hospital, Brown University, University of Tennessee Health Science Center, University of Miami, Unidade Local de Saúde de São José, Hospital de São José, University of Rochester Medicine, Universitätsmedizin Göttingen, University of Göttingen, Emory University, Thomas Jefferson University, University of Basel, University Hospital of Basel, University of Iowa Hospitals and Clinics, University of Pennsylvania, Boston University, Boston Medical Center, Valley Baptist Medical Center, Albert Einstein College of Medicine, Montefiore Medical Center, The University of Texas at San Antonio Health Science Center, Harvard University, Massachusetts General Hospital, Wake Forest University Health Sciences, Wake Forest University, Indiana University Indianapolis, King Fahd Hospital of the University, WellSpan Health, University of Calgary, NYU Langone Health, New York University, University of Toledo, Mercy St. Vincent Medical Center, Mercy Health, University of Virginia, University of Utah, Yale University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,300
OpenAlex ID: W7165033562