New Territory Infarction after Treatment Administration in ESCAPE trial

This study analyzed infarction in a new, previously unaffected territory after acute stroke treatment in a large randomized, controlled trial and re-affirmed that endovascular thrombectomy procedure is safe and elucidated that new territory infarcts are likely “epiphenomena” of the ischemic stroke process rather than a complication of stroke treatment.

The ESCAPE investigators previously proposed methodology to classify infarct in new territory (INT) into 6 types. From the 308 patients included in the analysis, 14 new territory infarcts (4.5% overall) were identified on follow-up CT or MRI. There was no difference in INT occurrence between the endovascular arm (5.0%) and the control arm (4.0%). The authors found that the use of IV tPA at baseline was associated with significant reduction of INT occurrence (3.0% vs. 9.1%).

These results were consistent with reports from other large randomized, controlled stroke intervention trials, although the methodology utilized by these authors is currently the best described and the analyses most comprehensive.