Philip Barber (Canada)
University of Calgary Clinical NeurosciencesAuthor Of 1 Presentation
THE EFFECT OF NEUROPROTECTANT NA1 ON EARLY INFARCT GROWTH FOLLOWING ENDOVASCULAR THERAPY: THE REPERFUSE-NA1 STUDY
Abstract
Background and Aims
Unfavourable outcome despite successful endovascular therapy (EVT) recanalization may be caused by substantial infarct growth that occurs despite successful reperfusion. The REPERFUSE-NA1 study replicated the preclinical NA1 experiment by investigating the effect of NA1 on early DWI infarct growth in acute ischemic stroke patients receiving EVT.
Methods
The REPERFUSE-NA1 was sub-study of the randomized controlled trial ESCAPE-NA1 (ClinicalTrialGov NCT02930018). Patients received MRI within 5 hours and 24 hours of EVT. The primary outcome was early diffusion weighted (DWI) Infarct growth.
Results
A total of 71 patients was included, of whom 67 had sufficient MR imaging at 5h and 24h post-EVT. For patients who received NA1 compared to placebo, the median age (68.8 v 67.5), baseline NIHSS (15.5 v 16), time from symptom onset to reperfusion (161 v 167 minutes) and mTICI 2b-3 (94.4% v 94.3%) were statistically not different. Median DWI volumes post-EVT (5h) were 13.0 mL (IQR, 5.9-28.1) in NA1 and 13.3 mL (IQR, 3.1-27.0) in placebo. At 24h median DWI volumes increased to 22.6 mL (IQR, 11.2-63.4) in the NA1 group and 22.4 mL (IQR, 7.4-52.3) in the placebo group, equating to a 48.4% DWI volume growth in the NA1 group and a 66.0% growth in the placebo group. Median DWI volume growth was 55.1% for NA1 patients who received alteplase compared to 41.3% for NA1 patients who did not receive alteplase (p=0.65).
Conclusions
The study did not show an effect of NA1 in reducing early DWI growth despite there being substantial DWI infarct growth in both NA1 and control groups.