Excellent recanalization and small core volumes are associated with favorable AMPAC score in patients with acute ischemic stroke secondary to large vessel occlusion

Background and aim Acute ischemic stroke due to large vessel occlusion (AIS-LVO) is a major cause of functional dependence, an important determinant of discharge disposition. The aim of this study is to assess the utility of pretreatment and interventional parameters as predictors of favorable Activity Measure for Post Acute Care (AMPAC) scores for optimal discharge planning. Methods In this retrospective multicenter analysis, inclusion criteria were as follows: a) CT angiography (CTA) confirmed LVO from 9/1/2017 to 9/22/2022; b) diagnostic CT perfusion; and c) available AMPAC scores. Patients were then dichotomized into favorable and unfavorable AMPAC for analysis. A multivariate logistic regression was performed using specific variables that were clinically relevant and significant on univariate regression analyses. A receiver operator characteristics (ROC) analysis was then performed to assess the diagnostic performance of the logistic regression model. A p value of <= 0.05 was considered significant. Results In total, 229 patients (mean +-SD 70.65 +-15.2 [55.9% female]) met our inclusion criteria. Favorable AMPAC patients were younger (61.3 versus 70.7, p < 0.0001), had lower admission glucose (mean, 124.19 versus 136.83, p = 0.042), lower blood urea nitrogen (mean, 15.59 versus 19.11, p = 0.0009), and lower admission National Institutes of Health Stroke Scale (NIHSS) (mean, 10.58 versus 16.15, p < 0.0001). 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 AMPAC (p<0.047 for all predictors). ROC analysis of 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 AMPAC. Our study further emphasizes the significance of minimizing core volume and aiming for excellent recanalization in order to optimize discharge disposition in AIS-LVO patients. ### Competing Interest Statement Drs. Greg Albers, Jeremy Heit, and Vivek Yedavalli are consultants for Rapid (iSchemaView, Menlo Park, CA) ### Clinical Trial N/A ### Funding Statement No funding to disclosure ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved through the Johns Hopkins School of Medicine institutional review board (JHU-IRB00269637). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data can be made available upon reasonable request