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- Title
Perfusion Imaging and Clinical Outcome in Acute Ischemic Stroke with Large Core.
- Authors
Seners, Pierre; Oppenheim, Catherine; Turc, Guillaume; Albucher, Jean‐François; Guenego, Adrien; Raposo, Nicolas; Christensen, Soren; Calvière, Lionel; Viguier, Alain; Darcourt, Jean; Januel, Anne‐Christine; Mlynash, Michael; Sommet, Agnes; Thalamas, Claire; Sibon, Igor; Rousseau, Vanessa; Tourdias, Thomas; Menegon, Patrice; Bonneville, Fabrice; Mazighi, Mikael
- Abstract
Objective: Mechanical thrombectomy (MT) is not recommended for acute stroke with large vessel occlusion (LVO) and a large volume of irreversibly injured tissue ("core"). Perfusion imaging may identify a subset of patients with large core who benefit from MT. Methods: We compared two cohorts of LVO‐related patients with large core (>50 ml on diffusion‐weighted‐imaging or CT‐perfusion using RAPID), available perfusion imaging, and treated within 6 hours from onset by either MT + Best Medical Management (BMM) in one prospective study, or BMM alone in the pre‐MT era from a prospective registry. Primary outcome was 90‐day modified Rankin Scale ≤2. We searched for an interaction between treatment group and amount of penumbra as estimated by the mismatch ratio (MMRatio = critical hypoperfusion/core volume). Results: Overall, 107 patients were included (56 MT + BMM and 51 BMM): Mean age was 68 ± 15 years, median core volume 99 ml (IQR: 72–131) and MMRatio 1.4 (IQR: 1.0–1.9). Baseline clinical and radiological variables were similar between the two groups, except for a higher intravenous thrombolysis rate in the BMM group. The MMRatio strongly modified the clinical outcome following MT (pinteraction < 0.001 for continuous MMRatio); MT was associated with a higher rate of good outcome in patients with, but not in those without, MMRatio>1.2 (adjusted OR [95% CI] = 6.8 [1.7–27.0] vs 0.7 [0.1–6.2], respectively). Similar findings were present for MMRatio ≥1.8 in the subgroup with core ≥70 ml. Parenchymal hemorrhage on follow‐up imaging was more frequent in the MT + BMM group regardless of the MMRatio. Interpretation: Perfusion imaging may help select which patients with large core should be considered for MT. Randomized studies are warranted. ANN NEUROL 2021;90:417–427
- Subjects
ISCHEMIC stroke; TREATMENT effectiveness; DIAGNOSTIC imaging; THROMBOLYTIC therapy; PERFUSION imaging
- Publication
Annals of Neurology, 2021, Vol 90, Issue 3, p417
- ISSN
0364-5134
- Publication type
Article
- DOI
10.1002/ana.26152