BACKGROUND AND PURPOSE: The purpose of this study was to determine the relationships between ischemic lesion growth, recanalization, and clinical response in stroke patients with and without a perfusion/diffusion mismatch. METHODS: DEFUSE is an open label multicenter study in which 74 consecutive acute stroke patients were treated with intravenous tPA 3 to 6 hours after stroke onset. Magnetic resonance imaging (MRI) scans were obtained before, 3 to 6 hours after, and 30 days after treatment. Lesion growth was defined as the difference between the final infarct volume (30 day FLAIR) and the baseline diffusion lesion. Baseline MRI profiles were used to categorize 44 patients into Mismatch versus Absence of Mismatch subgroups. Early recanalization was assessed in 28 patients with an initial vessel lesion on magnetic resonance angiography. Infarct growth was compared based on whether a favorable clinical response (FCR) occurred and whether early recanalization was achieved. RESULTS: In the Mismatch subgroup, FCR was associated with less infarct growth P=0.03 and early recanalization was predictive of both FCR (odds ratio: 22, P=0.047) and reduced infarct growth P=0.024. There was no significant relationship between recanalization, infarct growth, and clinical outcome in the Absence of Mismatch subgroup. A threshold of <7 cc of growth had the highest sensitivity and specificity for predicting a FCR in Mismatch patients (odds ratio: 65, P=0.015, sensitivity 82%, specificity 75%). CONCLUSIONS: In contrast to Absence of Mismatch patients, significant associations between recanalization, reduced infarct growth, and favorable clinical response were documented in patients with a perfusion/diffusion mismatch who were treated with tPA within 3 to 6 hours after stroke onset. These findings support the Mismatch hypothesis but require validation in a larger study.
BACKGROUND AND PURPOSE: The purpose of this study was to determine the relationships between ischemic lesion growth, recanalization, and clinical response in strokepatients with and without a perfusion/diffusion mismatch. METHODS: DEFUSE is an open label multicenter study in which 74 consecutive acute strokepatients were treated with intravenous tPA 3 to 6 hours after stroke onset. Magnetic resonance imaging (MRI) scans were obtained before, 3 to 6 hours after, and 30 days after treatment. Lesion growth was defined as the difference between the final infarct volume (30 day FLAIR) and the baseline diffusion lesion. Baseline MRI profiles were used to categorize 44 patients into Mismatch versus Absence of Mismatch subgroups. Early recanalization was assessed in 28 patients with an initial vessel lesion on magnetic resonance angiography. Infarct growth was compared based on whether a favorable clinical response (FCR) occurred and whether early recanalization was achieved. RESULTS: In the Mismatch subgroup, FCR was associated with less infarct growth P=0.03 and early recanalization was predictive of both FCR (odds ratio: 22, P=0.047) and reduced infarct growth P=0.024. There was no significant relationship between recanalization, infarct growth, and clinical outcome in the Absence of Mismatch subgroup. A threshold of <7 cc of growth had the highest sensitivity and specificity for predicting a FCR in Mismatch patients (odds ratio: 65, P=0.015, sensitivity 82%, specificity 75%). CONCLUSIONS: In contrast to Absence of Mismatch patients, significant associations between recanalization, reduced infarct growth, and favorable clinical response were documented in patients with a perfusion/diffusion mismatch who were treated with tPA within 3 to 6 hours after stroke onset. These findings support the Mismatch hypothesis but require validation in a larger study.
Authors: G J del Zoppo; K Poeck; M S Pessin; S M Wolpert; A J Furlan; A Ferbert; M J Alberts; J A Zivin; L Wechsler; O Busse Journal: Ann Neurol Date: 1992-07 Impact factor: 10.422
Authors: Julio A Chalela; Chelsea S Kidwell; Lauren M Nentwich; Marie Luby; John A Butman; Andrew M Demchuk; Michael D Hill; Nicholas Patronas; Lawrence Latour; Steven Warach Journal: Lancet Date: 2007-01-27 Impact factor: 79.321
Authors: Steven Warach; David Kaufman; David Chiu; Thomas Devlin; Marie Luby; Ajaz Rashid; Linda Clayton; Markku Kaste; Kennedy R Lees; Ralph Sacco; Marc Fisher Journal: Cerebrovasc Dis Date: 2005-12-09 Impact factor: 2.762
Authors: Mark W Parsons; P Alan Barber; Jonathon Chalk; David G Darby; Stephen Rose; Patricia M Desmond; Richard P Gerraty; Brian M Tress; Peter M Wright; Geoffrey A Donnan; Stephen M Davis Journal: Ann Neurol Date: 2002-01 Impact factor: 10.422
Authors: Werner Hacke; Greg Albers; Yasir Al-Rawi; Julien Bogousslavsky; Antonio Davalos; Michael Eliasziw; Michael Fischer; Anthony Furlan; Markku Kaste; Kennedy R Lees; Mariola Soehngen; Steven Warach Journal: Stroke Date: 2004-11-29 Impact factor: 7.914
Authors: Stephen Davis; Bruce Campbell; Soren Christensen; Henry Ma; Patricia Desmond; Mark Parsons; Christopher Levi; Christopher Bladin; P Alan Barber; Geoffrey Donnan Journal: Transl Stroke Res Date: 2012-04-18 Impact factor: 6.829
Authors: Bruce C V Campbell; Søren Christensen; Brian M Tress; Leonid Churilov; Patricia M Desmond; Mark W Parsons; P Alan Barber; Christopher R Levi; Christopher Bladin; Geoffrey A Donnan; Stephen M Davis Journal: J Cereb Blood Flow Metab Date: 2013-05-08 Impact factor: 6.200
Authors: Edwin M Nemoto; Oscar Mendez; Mary E Kerr; Andrew Firlik; Kevin Stevenson; Tudor Jovin; Howard Yonas Journal: Transl Stroke Res Date: 2012-05-30 Impact factor: 6.829
Authors: Jean-Marc Olivot; Michael Mlynash; Vincent N Thijs; Archana Purushotham; Stephanie Kemp; Maarten G Lansberg; Lawrence Wechsler; Roland Bammer; Michael P Marks; Gregory W Albers Journal: Stroke Date: 2009-03-19 Impact factor: 7.914