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

Archives of Rehabilitation Research and Clinical Translation (Dec 2023)

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, MD, MS,
Manisha Koneru, MS,
Meisam Hoseinyazdi, MD,
Karen Copeland, PhD,
Risheng Xu, MD, PhD,
Licia Luna, MD, PhD,
Justin Caplan, MD,
Adam Dmytriw, MD, MPH, MSc,
Adrien Guenego, MD, PhD,
Jeremy Heit, MD, PhD,
Gregory Albers, MD,
Max Wintermark, MD, MS, MBA,
Fernando Gonzalez, MD,
Victor Urrutia, MD,
Judy Huang, MD,
Richard Leigh, MD,
Elisabeth Marsh, MD,
Rafael Llinas, MD,
Marlis Gonzalez Hernandez, MD, PhD,
Argye Hillis, MD

Affiliations

Vivek Yedavalli, MD, MS: Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD; Corresponding author Vivek Yedavalli, MD, MS, Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Phipps B122-D, Baltimore, MD 21287.
Manisha Koneru, MS: Cooper Medical School of Rowan University, Camden, NJ
Meisam Hoseinyazdi, MD: Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD
Karen Copeland, PhD: Boulder Statistics, Boulder, CO
Risheng Xu, MD, PhD: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
Licia Luna, MD, PhD: Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD
Justin Caplan, MD: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
Adam Dmytriw, MD, MPH, MSc: Department of Neuroradiology, Massachusetts General Hospital & Harvard Medical School, Cambridge, MA
Adrien Guenego, MD, PhD: Department of Radiology, Université Libre De Bruxelles Hospital Erasme, Brussels, BE
Jeremy Heit, MD, PhD: Department of Radiology, Stanford University School of Medicine, Palo Alto, CA
Gregory Albers, MD: Department of Neurology, Stanford University School of Medicine, Baltimore, MD
Max Wintermark, MD, MS, MBA: Department of Radiology, University of Texas MD Anderson Center, Houston, TX
Fernando Gonzalez, MD: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
Victor Urrutia, MD: Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
Judy Huang, MD: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
Richard Leigh, MD: Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
Elisabeth Marsh, MD: Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
Rafael Llinas, MD: Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
Marlis Gonzalez Hernandez, MD, PhD: Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
Argye Hillis, MD: Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Journal volume & issue: Vol. 5, no. 4
p. 100306

Abstract

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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.

Published in Archives of Rehabilitation Research and Clinical Translation

ISSN: 2590-1095 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Medicine (General)
Website: https://www.journals.elsevier.com/archives-of-rehabilitation-research-and-clinical-translation

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