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Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy
BACKGROUND AND PURPOSE: Patients with acute ischemic stroke, proximal vessel occlusion and a large ischemic core at presentation are commonly not considered for mechanical thrombectomy (MT). We tested the hypothesis that in patients with baseline large infarct cores, identification of remaining penu...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Stroke Society
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341008/ https://www.ncbi.nlm.nih.gov/pubmed/32635686 http://dx.doi.org/10.5853/jos.2019.02908 |
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author | Kerleroux, Basile Janot, Kevin Dargazanli, Cyril Daly-Eraya, Dimitri Ben-Hassen, Wagih Zhu, François Gory, Benjamin Hak, Jean François Perot, Charline Detraz, Lili Bourcier, Romain Rouchaud, Aymeric Forestier, Géraud Benzakoun, Joseph Marnat, Gaultier Gariel, Florent Mordasini, Pasquale Kaesmacher, Johannes Boulouis, Grégoire |
author_facet | Kerleroux, Basile Janot, Kevin Dargazanli, Cyril Daly-Eraya, Dimitri Ben-Hassen, Wagih Zhu, François Gory, Benjamin Hak, Jean François Perot, Charline Detraz, Lili Bourcier, Romain Rouchaud, Aymeric Forestier, Géraud Benzakoun, Joseph Marnat, Gaultier Gariel, Florent Mordasini, Pasquale Kaesmacher, Johannes Boulouis, Grégoire |
author_sort | Kerleroux, Basile |
collection | PubMed |
description | BACKGROUND AND PURPOSE: Patients with acute ischemic stroke, proximal vessel occlusion and a large ischemic core at presentation are commonly not considered for mechanical thrombectomy (MT). We tested the hypothesis that in patients with baseline large infarct cores, identification of remaining penumbral tissue using perfusion imaging would translate to better outcomes after MT. METHODS: This was a multicenter, retrospective, core lab adjudicated, cohort study of adult patients with proximal vessel occlusion, a large ischemic core volume (diffusion weighted imaging volume ≥70 mL), with pre-treatment magnetic resonance imaging perfusion, treated with MT (2015 to 2018) or medical care alone (controls; before 2015). Primary outcome measure was 3-month favorable outcome (defined as a modified Rankin Scale of 0–3). Core perfusion mismatch ratio (CPMR) was defined as the volume of critically hypo-perfused tissue (Tmax >6 seconds) divided by the core volume. Multivariable logistic regression models were used to determine factors that were independently associated with clinical outcomes. Outputs are displayed as adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS: A total of 172 patients were included (MT n=130; Control n=42; mean age 69.0±15.4 years; 36% females). Mean core-volume and CPMR were 102.3±36.7 and 1.8±0.7 mL, respectively. As hypothesized, receiving MT was associated with increased probability of favorable outcome and functional independence, as CPMR increased, a difference becoming statistically significant above a mismatch-ratio of 1.72. Similarly, receiving MT was also associated with favorable outcome in the subgroup of 74 patients with CPMR >1.7 (aOR, 8.12; 95% CI, 1.24 to 53.11; P=0.028). Overall (prior to stratification by CPMR) 73 (42.4%) patients had a favorable outcome at 3 months, with no difference amongst groups. CONCLUSIONS: In patients currently deemed ineligible for MT due to large infarct ischemic cores at baseline, CPMR identifies a subgroup strongly benefiting from MT. Prospective studies are warranted. |
format | Online Article Text |
id | pubmed-7341008 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Korean Stroke Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-73410082020-07-17 Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy Kerleroux, Basile Janot, Kevin Dargazanli, Cyril Daly-Eraya, Dimitri Ben-Hassen, Wagih Zhu, François Gory, Benjamin Hak, Jean François Perot, Charline Detraz, Lili Bourcier, Romain Rouchaud, Aymeric Forestier, Géraud Benzakoun, Joseph Marnat, Gaultier Gariel, Florent Mordasini, Pasquale Kaesmacher, Johannes Boulouis, Grégoire J Stroke Original Article BACKGROUND AND PURPOSE: Patients with acute ischemic stroke, proximal vessel occlusion and a large ischemic core at presentation are commonly not considered for mechanical thrombectomy (MT). We tested the hypothesis that in patients with baseline large infarct cores, identification of remaining penumbral tissue using perfusion imaging would translate to better outcomes after MT. METHODS: This was a multicenter, retrospective, core lab adjudicated, cohort study of adult patients with proximal vessel occlusion, a large ischemic core volume (diffusion weighted imaging volume ≥70 mL), with pre-treatment magnetic resonance imaging perfusion, treated with MT (2015 to 2018) or medical care alone (controls; before 2015). Primary outcome measure was 3-month favorable outcome (defined as a modified Rankin Scale of 0–3). Core perfusion mismatch ratio (CPMR) was defined as the volume of critically hypo-perfused tissue (Tmax >6 seconds) divided by the core volume. Multivariable logistic regression models were used to determine factors that were independently associated with clinical outcomes. Outputs are displayed as adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS: A total of 172 patients were included (MT n=130; Control n=42; mean age 69.0±15.4 years; 36% females). Mean core-volume and CPMR were 102.3±36.7 and 1.8±0.7 mL, respectively. As hypothesized, receiving MT was associated with increased probability of favorable outcome and functional independence, as CPMR increased, a difference becoming statistically significant above a mismatch-ratio of 1.72. Similarly, receiving MT was also associated with favorable outcome in the subgroup of 74 patients with CPMR >1.7 (aOR, 8.12; 95% CI, 1.24 to 53.11; P=0.028). Overall (prior to stratification by CPMR) 73 (42.4%) patients had a favorable outcome at 3 months, with no difference amongst groups. CONCLUSIONS: In patients currently deemed ineligible for MT due to large infarct ischemic cores at baseline, CPMR identifies a subgroup strongly benefiting from MT. Prospective studies are warranted. Korean Stroke Society 2020-05 2020-05-31 /pmc/articles/PMC7341008/ /pubmed/32635686 http://dx.doi.org/10.5853/jos.2019.02908 Text en Copyright © 2020 Korean Stroke Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Kerleroux, Basile Janot, Kevin Dargazanli, Cyril Daly-Eraya, Dimitri Ben-Hassen, Wagih Zhu, François Gory, Benjamin Hak, Jean François Perot, Charline Detraz, Lili Bourcier, Romain Rouchaud, Aymeric Forestier, Géraud Benzakoun, Joseph Marnat, Gaultier Gariel, Florent Mordasini, Pasquale Kaesmacher, Johannes Boulouis, Grégoire Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy |
title | Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy |
title_full | Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy |
title_fullStr | Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy |
title_full_unstemmed | Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy |
title_short | Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy |
title_sort | perfusion imaging to select patients with large ischemic core for mechanical thrombectomy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341008/ https://www.ncbi.nlm.nih.gov/pubmed/32635686 http://dx.doi.org/10.5853/jos.2019.02908 |
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