Lesion Water Content on CT Predicts 12-Month Outcome and Modifies Thrombectomy Effect in Large-Core Stroke-A Secondary Analysis of the TENSION Trial.
Gabriel Broocks, Martin Bendszus, Sophia Hohenstatt et al.
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In 30 seconds
This secondary analysis of the randomized TENSION trial examined whether CT-derived net water uptake (NWU) predicts 12-month outcomes and modifies thrombectomy effects in 198 patients with large-core ischemic stroke. Higher baseline NWU independently predicted worse ordinal modified Rankin Scale (mRS) outcome and interacted with endovascular thrombectomy (EVT): the interaction adjusted common odds ratio was 1.17 (95% CI, 1.06-1.30; P = 0.002). Follow-up NWU at 24 hours was the strongest single imaging predictor of 12-month outcome, with an AUC of 0.78 for mRS 0-3, and superseded baseline NWU when both were modelled.
Key findings
- Higher baseline NWU predicted worse 12-month mRS (adjusted common odds ratio, 1.10 per percentage-point; 95% CI, 1.05-1.16; P < 0.001).
- Baseline NWU modified the EVT effect (interaction adjusted common odds ratio, 1.17; 95% CI, 1.06-1.30; P = 0.002).
- Follow-up NWU was the strongest single imaging predictor (adjusted common odds ratio, 1.10; 95% CI, 1.06-1.14; P < 0.001; AUC, 0.78 for mRS 0-3).
- Among 97 90-day survivors, higher follow-up NWU independently predicted late mortality (adjusted odds ratio, 1.09; 95% CI, 1.02-1.18; P = 0.019).
Why it matters
CT-derived lesion water content may capture injury information beyond lesion extent and could help explain variation in long-term outcomes after large-core stroke. The observed interaction with EVT suggests baseline NWU may be relevant to treatment-effect assessment, while follow-up NWU may provide prognostic information about realized injury. These findings support further evaluation of NWU as an imaging biomarker.
What to keep in mind
This was a secondary analysis restricted to patients with suitable admission CT and available 12-month mRS; follow-up NWU was available for fewer patients. The findings establish prognostic associations and an interaction within this trial, not a validated treatment-selection rule.