BACKGROUND: Reperfusion is associated with good functional outcome after stroke. However, minimal data are available regarding the effect of reperfusion on clinical outcome and infarct growth in patients with distal MCA branch occlusions. AIM: The aim of this study was to evaluate this association and to determine the impact of the perfusion-diffusion mismatch. METHODS: Individual patient data from three stroke studies (EPITHET, DEFUSE and DEFUSE 2) with baseline MRI profiles and reperfusion status were pooled. Patients were included if they had a single cortical perfusion lesion on their baseline MRI that was consistent with a distal MCA branch occlusion. Good functional outcome was defined as a score of 0-2 on the modified Rankin Scale at day 90 and infarct growth was defined as change in lesion volume between the baseline DWI and the final T2/FLAIR. RESULTS: Thirty patients met inclusion criteria. Eighteen (60%) had a good functional outcome and twenty (67%) had reperfusion. Reperfusion was not associated with good functional outcome in the overall cohort (OR: 1·0, 95% CI 0·2-4·7) and also not in the subset of patients with a PWI-DWI mismatch (n = 17; OR: 0·7, 95% CI 0·1-5·5). Median infarct growth was modest and not significantly different between patients with (0 ml) and without reperfusion (6 ml); P = 0·2. CONCLUSIONS: The overall high rate of good outcomes in patients with distal MCA perfusion lesions might obscure a potential benefit from reperfusion in this population. A larger pooled analysis evaluating the effect of reperfusion in patients with distal MCA branch occlusions is warranted as confirmation of our results could have implications for the design of future stroke trials.
BACKGROUND: Reperfusion is associated with good functional outcome after stroke. However, minimal data are available regarding the effect of reperfusion on clinical outcome and infarct growth in patients with distal MCA branch occlusions. AIM: The aim of this study was to evaluate this association and to determine the impact of the perfusion-diffusion mismatch. METHODS: Individual patient data from three stroke studies (EPITHET, DEFUSE and DEFUSE 2) with baseline MRI profiles and reperfusion status were pooled. Patients were included if they had a single cortical perfusion lesion on their baseline MRI that was consistent with a distal MCA branch occlusion. Good functional outcome was defined as a score of 0-2 on the modified Rankin Scale at day 90 and infarct growth was defined as change in lesion volume between the baseline DWI and the final T2/FLAIR. RESULTS: Thirty patients met inclusion criteria. Eighteen (60%) had a good functional outcome and twenty (67%) had reperfusion. Reperfusion was not associated with good functional outcome in the overall cohort (OR: 1·0, 95% CI 0·2-4·7) and also not in the subset of patients with a PWI-DWI mismatch (n = 17; OR: 0·7, 95% CI 0·1-5·5). Median infarct growth was modest and not significantly different between patients with (0 ml) and without reperfusion (6 ml); P = 0·2. CONCLUSIONS: The overall high rate of good outcomes in patients with distal MCA perfusion lesions might obscure a potential benefit from reperfusion in this population. A larger pooled analysis evaluating the effect of reperfusion in patients with distal MCA branch occlusions is warranted as confirmation of our results could have implications for the design of future stroke trials.
Authors: Nils Wahlgren; Niaz Ahmed; Antoni Dávalos; Gary A Ford; Martin Grond; Werner Hacke; Michael G Hennerici; Markku Kaste; Sonja Kuelkens; Vincent Larrue; Kennedy R Lees; Risto O Roine; Lauri Soinne; Danilo Toni; Geert Vanhooren Journal: Lancet Date: 2007-01-27 Impact factor: 79.321
Authors: Maarten G Lansberg; Matus Straka; Stephanie Kemp; Michael Mlynash; Lawrence R Wechsler; Tudor G Jovin; Michael J Wilder; Helmi L Lutsep; Todd J Czartoski; Richard A Bernstein; Cherylee W J Chang; Steven Warach; Franz Fazekas; Manabu Inoue; Aaryani Tipirneni; Scott A Hamilton; Greg Zaharchuk; Michael P Marks; Roland Bammer; Gregory W Albers Journal: Lancet Neurol Date: 2012-09-04 Impact factor: 44.182
Authors: Gregory W Albers; Vincent N Thijs; Lawrence Wechsler; Stephanie Kemp; Gottfried Schlaug; Elaine Skalabrin; Roland Bammer; Wataru Kakuda; Maarten G Lansberg; Ashfaq Shuaib; William Coplin; Scott Hamilton; Michael Moseley; Michael P Marks Journal: Ann Neurol Date: 2006-11 Impact factor: 10.422
Authors: Maher Saqqur; Ken Uchino; Andrew M Demchuk; Carlos A Molina; Zsolt Garami; Sergio Calleja; Naveed Akhtar; Finton O Orouk; Abdul Salam; Ashfaq Shuaib; Andrei V Alexandrov Journal: Stroke Date: 2007-02-08 Impact factor: 7.914
Authors: Ralph Rahme; Todd A Abruzzo; Renee' Hebert Martin; Thomas A Tomsick; Andrew J Ringer; Anthony J Furlan; Janice A Carrozzella; Pooja Khatri Journal: Stroke Date: 2012-12-06 Impact factor: 7.914
Authors: Stephen M Davis; Geoffrey A Donnan; Mark W Parsons; Christopher Levi; Kenneth S Butcher; Andre Peeters; P Alan Barber; Christopher Bladin; Deidre A De Silva; Graham Byrnes; Jonathan B Chalk; John N Fink; Thomas E Kimber; David Schultz; Peter J Hand; Judith Frayne; Graeme Hankey; Keith Muir; Richard Gerraty; Brian M Tress; Patricia M Desmond Journal: Lancet Neurol Date: 2008-02-28 Impact factor: 44.182
Authors: Robin Lemmens; Scott A Hamilton; David S Liebeskind; Tom A Tomsick; Andrew M Demchuk; Raul G Nogueira; Michael P Marks; Reza Jahan; Jan Gralla; Albert J Yoo; Sharon D Yeatts; Yuko Y Palesch; Jeffrey L Saver; Vitor M Pereira; Joseph P Broderick; Gregory W Albers; Maarten G Lansberg Journal: Neurology Date: 2016-01-22 Impact factor: 9.910
Authors: Nishant K Mishra; Gregory W Albers; Søren Christensen; Michael Marks; Scott Hamilton; Matus Straka; John T P Liggins; Stephanie Kemp; Michael Mlynash; Roland Bammer; Maarten G Lansberg Journal: Stroke Date: 2014-04-03 Impact factor: 7.914