We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke.
- Authors
Ozenne, Brice; Cho, Tae‐Hee; Mikkelsen, Irene Klærke; Hermier, Marc; Ribe, Lars; Thomalla, Götz; Pedraza, Salvador; Baron, Jean‐Claude; Roy, Pascal; Berthezène, Yves; Nighoghossian, Norbert; Østergaard, Leif; Maucort‐Boulch, Delphine
- Abstract
<bold>Background and Purpose: </bold>Though still debated, early reperfusion is increasingly used as a biomarker for clinical outcome. However, the lack of a standard definition hinders the assessment of reperfusion therapies and study comparisons. The objective was to determine the optimal early reperfusion criteria that predicts clinical outcome in ischemic stroke. <bold>Methods: </bold>Early reperfusion was assessed voxel-wise in 57 patients within 6 hours of symptom onset. The performance of the time to peak (TTP), the mean transit time (MTT), and the time to maximum of residue function (Tmax ) at various delays thresholds in predicting the neurological response (based on the National Institutes of Health Stroke Scale) and the functional outcome (modified Rankin scale ≤1) at 1 month were compared. A receiver operating characteristics (ROC) analysis determined the optimal extent of reperfusion. A novel unsupervised classification of reperfusion using group-based trajectory modeling (GBTM) was evaluated. <bold>Results: </bold>MTT had a lower performance than TTP and Tmax in predicting the neurological response (P = .008 vs. TTP and P = .006 vs. Tmax ) or the functional outcome (P = .0006 vs. TTP; P = .002 vs. Tmax ). No delay threshold had a significantly higher predictive value than another. The optimal percentage of reperfusion was dependent on the outcome scale (P < .001). The GBTM-based classification of reperfusion was closely associated with the clinical outcome and had a similar accuracy compared to ROC-based classification. <bold>Conclusions: </bold>TTP and Tmax should be preferred to MTT in defining early reperfusion. GBTM provided a clinically relevant reperfusion classification that does not require prespecified delay thresholds or clinical outcomes.
- Subjects
THERAPEUTIC use of fibrinolytic agents; TISSUE plasminogen activator; CEREBRAL circulation; CEREBRAL ischemia; COMPARATIVE studies; MAGNETIC resonance imaging; RESEARCH methodology; MEDICAL cooperation; REPERFUSION; RESEARCH; STROKE; THROMBOLYTIC therapy; EVALUATION research; TREATMENT effectiveness; MAGNETIC resonance angiography; NIH Stroke Scale; THERAPEUTICS
- Publication
Journal of Neuroimaging, 2015, Vol 25, Issue 6, p952
- ISSN
1051-2284
- Publication type
journal article
- DOI
10.1111/jon.12255