Excellent Recanalization and Small Core Volumes Are Associated With Favorable AM-PAC Score in Patients With Acute Ischemic Stroke Secondary to Large Vessel Occlusion

Vivek Yedavalli; Manisha Koneru; Meisam Hoseinyazdi; Karen Copeland; Risheng Xu; Licia Luna; Justin Caplan; Adam Dmytriw; Adrien Guenego; Jeremy Heit; Gregory Albers; Max Wintermark; Fernando Gonzalez; Victor Urrutia; Judy Huang; Richard Leigh; Elisabeth Marsh; Rafael Llinas; Marlis Gonzalez Hernandez; Argye Hillis

doi:10.1016/j.arrct.2023.100306

Excellent Recanalization and Small Core Volumes Are Associated With Favorable AM-PAC Score in Patients With Acute Ischemic Stroke Secondary to Large Vessel Occlusion

Arch Rehabil Res Clin Transl. 2023 Oct 26;5(4):100306. doi: 10.1016/j.arrct.2023.100306. eCollection 2023 Dec.

Authors

Vivek Yedavalli¹, Manisha Koneru², Meisam Hoseinyazdi¹, Karen Copeland³, Risheng Xu⁴, Licia Luna¹, Justin Caplan⁴, Adam Dmytriw⁵, Adrien Guenego⁶, Jeremy Heit⁷, Gregory Albers⁸, Max Wintermark⁹, Fernando Gonzalez⁴, Victor Urrutia¹⁰, Judy Huang⁴, Richard Leigh¹⁰, Elisabeth Marsh¹⁰, Rafael Llinas¹⁰, Marlis Gonzalez Hernandez¹⁰, Argye Hillis¹⁰

Affiliations

¹ Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD.
² Cooper Medical School of Rowan University, Camden, NJ.
³ Boulder Statistics, Boulder, CO.
⁴ Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD.
⁵ Department of Neuroradiology, Massachusetts General Hospital & Harvard Medical School, Cambridge, MA.
⁶ Department of Radiology, Université Libre De Bruxelles Hospital Erasme, Brussels, BE.
⁷ Department of Radiology, Stanford University School of Medicine, Palo Alto, CA.
⁸ Department of Neurology, Stanford University School of Medicine, Baltimore, MD.
⁹ Department of Radiology, University of Texas MD Anderson Center, Houston, TX.
¹⁰ Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD.

Abstract

Objective: To assess pretreatment and interventional parameters as predictors of favorable Activity Measure for Post-Acute Care (AM-PAC) scores for optimal discharge planning.

Design: In this prospectively collected, retrospectively reviewed multicenter study from 9/1/2017 to 9/22/2022, patients were dichotomized into favorable and unfavorable AM-PAC. Multivariate logistic regression and receiver operator characteristics analyses were performed for the identified significant variables. A P value of ≤.05 was significant.

Setting: Hospitalized care.

Participants: In total, 229 patients (mean ±SD 70.65 ±15.2 [55.9% women]) met our inclusion criteria. Inclusion criteria were (a) computed tomography (CT) angiography confirmed LVO from 9/1/2017 to 9/22/2022; (b) diagnostic CT perfusion; and (c) available AM-PAC scores.

Interventions: None.

Main outcome measures: Favorable AM-PAC, defined as a daily activity score ≥19 and basic mobility score of ≥17.

Results: Patients with favorable AM-PAC were younger (61.3 vs 70.7, P<.001), had lower admission glucose (mean, 124 vs 136, P=.042), lower blood urea nitrogen (mean, 15.59 vs 19.11, P<.001), and lower admission National Institutes of Health Stroke Scale (NIHSS) (mean, 10.58 vs 16.15, P<.001). No differences in sex were noted. Multivariate regression analyses revealed age, admission NIHSS, relative cerebral blood flow (rCBF) <30% volume, and modified thrombolysis in cerebral infarction (mTICI) score to be independent predictors of favorable AM-PAC (P<.047 for all predictors). The combined model revealed an area under the curve (AUC) of 0.83 (IQR 0.75-0.86).

Conclusion: Excellent recanalization, smaller core volumes, younger age, and lower stroke severity independently predict favorable outcomes as measured by AM-PAC.

Keywords: AMPAC; Acute ischemic stroke; CT; Rehabilitation; perfusion imaging.