Journal article
Final Infarct Volume as a Surrogate End Point in Anterior Circulation ICAS-LVO Stroke: Post Hoc Secondary Analysis of RESCUE-ICAS
Stroke: vascular and interventional neurology, Vol.6(4), e002105
06/17/2026
DOI: 10.1161/SVIN.125.002105
PMID: 42404842
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.
Details
- Title: Subtitle
- Final Infarct Volume as a Surrogate End Point in Anterior Circulation ICAS-LVO Stroke: Post Hoc Secondary Analysis of RESCUE-ICAS
- Creators
- Ahmad Abu Qdais - Medical University of South CarolinaMustafa Ismail - Medical University of South CarolinaAhmed Abdelwahab - Medical University of South CarolinaEyad Almallouhi - Sarasota Memorial HospitalShadi Yaghi - Brown UniversityVioliza Inoa-Acosta - University of Tennessee Health Science CenterFrancesco Capasso - University of FlorenceMichael Nahhas - University of HoustonRobert M. Starke - University of MiamiIsabel Fragata - Hospital de São JoséMatthew T. Bender - University of Rochester Medical CenterKrisztina Moldovan - Brown UniversityIlko Maier - University of GöttingenJonathan A. Grossberg - Emory UniversityPascal Jabbour - Thomas Jefferson UniversityMarios Psychogios - University Hospital of BaselEdgar A. Samaniego - University of Iowa Hospitals and ClinicsJan-Karl Burkhardt - University of PennsylvaniaBrian Jankowitz - University of PennsylvaniaMohamad Abdalkader - Boston Medical CenterAshley Choi - Medical University of South CarolinaAmeer E. Hassan - Valley Baptist Medical CenterDavid Altschul - Albert Einstein College of MedicineJustin Mascitelli - The University of Texas at San Antonio Health Science CenterRobert W. Regenhardt - Massachusetts General HospitalStacey Wolfe - Wake Forest UniversityMohamad Ezzeldin - Lone Star College KingwoodKaustubh Limaye - Indiana University – Purdue University IndianapolisHosam Al Jehani - Department of Neurosurgery, King Fahad Hospital of the University, Alkhobar, Saudi Arabia (H.A.J.)Muhammad H. Niazi - WellSpan HealthNitin Goyal - Semmes Murphey FoundationStavropoula Tjoumakaris - Thomas Jefferson UniversityAli Alawieh - Emory UniversityMohammed Almekhlafi - University of CalgaryEytan Raz - NYU Langone HealthAdam Mierzwa - University of ToledoSyed Zaidi - University of ToledoAlejandro M. Spiotta - Medical University of South CarolinaKimberly Kicielinski - Medical University of South CarolinaJonathan Lena - Medical University of South CarolinaZachary Hubbard - Medical University of South CarolinaOsama O. Zaidat - Mercy St. Vincent Medical CenterColin P. Derdeyn - University of VirginiaRamesh Grandhi - University of UtahThanh N. Nguyen - Boston Medical CenterAdam de Havenon - Yale UniversitySami Al Kasab - Medical University of South CarolinaMouhammad Jumaa - University of Toledo
- Resource Type
- Journal article
- Publication Details
- Stroke: vascular and interventional neurology, Vol.6(4), e002105
- DOI
- 10.1161/SVIN.125.002105
- PMID
- 42404842
- ISSN
- 2694-5746
- eISSN
- 2694-5746
- Publisher
- Wolters Kluwer Health
- Language
- English
- Date published
- 06/17/2026
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9985179854802771
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