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- Title
Tenacity of Collateral Perfusion in Proximal Cerebral Arterial Occlusions 6–12 h after Onset.
- Authors
Kim, Beom Joon; Kim, Hyeran; Jeong, Han-Gil; Yang, Mi Hwa; Jung, Cheol Kyu; Han, Moon-Ku; Kim, Jae Hyoung ; Demchuk, Andrew M.; Bae, Hee-Joon
- Abstract
<bold>Background:</bold> Clinical trials have shown that benefits of endovascular recanalization (EVT) for acute ischemic stroke patients with sizable penumbral tissues seems plausible even beyond 6 h after their last seen normal (LSN). Persistency of ischemic penumbra remains unclear in delayed periods. <bold>Methods:</bold> From a prospective stroke registry database, we identified 111 acute ischemic stroke patients who had internal carotid artery or middle cerebral artery occlusion with baseline National Institutes of Health Stroke Scale scores ≥6 points and arrived 6–12 h after LSN. Baseline information and functional outcomes were prospectively collected as a clinical registry. Attending physicians made treatment decisions for EVT based on the current guidelines and institutional protocols. MR image parameters, including the volume of diffusion-restricted lesions and mapping of the hypoperfused area, were quantified using automated commercial software. Binary logistic regression analysis models, with modified Rankin Scale (mRS) scores of 0–1 at 3 months after stroke included as a dependent variable, were constructed. <bold>Results:</bold> Between 6 and 12 h after onset, 58% had a mismatch ratio of ≥1.8 at baseline and 42% had favorable imaging profiles as determined by DEFUSE 2 study. After 9 h, there was a mismatch ratio of ≥1.8 in 47 and 38% favorable profiles. EVT was performed in 54% of cases. A 3-month mRS score of 0–1 was found in 19% (25% in EVT and 12% in medical treatment groups) of cases. EVT was associated with an increased OR of having a mRS score of 0–1 at 3 months after stroke (adjusted OR 7.59 [95% CI 1.28–61.60]). <bold>Conclusions:</bold> Penumbral tissues were persistent in a substantial proportion of anterior circulation occlusion cases 6–12 h after LSN. EVT at 6–12 h in a predominantly Asian cohort resulted in better outcomes.
- Subjects
CEREBRAL arterial diseases; ENDOVASCULAR surgery; CLINICAL trials; THERAPEUTICS
- Publication
Cerebrovascular Diseases, 2018, Vol 45, Issue 5/6, p263
- ISSN
1015-9770
- Publication type
Article
- DOI
10.1159/000489894