Maarten G Lansberg1, Carlo W Cereda2, Michael Mlynash2, Nishant K Mishra2, Manabu Inoue2, Stephanie Kemp2, Søren Christensen2, Matus Straka2, Greg Zaharchuk2, Michael P Marks2, Roland Bammer2, Gregory W Albers2. 1. From the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland. lansberg@stanford.edu. 2. From the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Abstract
OBJECTIVE: To evaluate whether time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on MRI. METHODS: Patients from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) cohort study with a perfusion-diffusion target mismatch were included. Reperfusion was defined as a decrease in the perfusion lesion volume of at least 50% between baseline and early follow-up. Good functional outcome was defined as a modified Rankin Scale score ≤2 at day 90. Lesion growth was defined as the difference between the baseline and the early follow-up diffusion-weighted imaging lesion volumes. RESULTS: Among 78 patients with the target mismatch profile (mean age 66 ± 16 years, 54% women), reperfusion was associated with increased odds of good functional outcome (adjusted odds ratio 3.7, 95% confidence interval 1.2-12, p = 0.03) and attenuation of lesion growth (p = 0.02). Time to treatment did not modify these effects (p value for the time × reperfusion interaction is 0.6 for good functional outcome and 0.3 for lesion growth). Similarly, in the subgroup of patients with reperfusion (n = 46), time to treatment was not associated with good functional outcome (p = 0.2). CONCLUSION: The association between endovascular reperfusion and improved functional and radiologic outcomes is not time-dependent in patients with a perfusion-diffusion mismatch. Proof that patients with mismatch benefit fromendovascular therapy in the late time window should come from a randomized placebo-controlled trial.
RCT Entities:
OBJECTIVE: To evaluate whether time to treatment modifies the effect of endovascular reperfusion in strokepatients with evidence of salvageable tissue on MRI. METHODS:Patients from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) cohort study with a perfusion-diffusion target mismatch were included. Reperfusion was defined as a decrease in the perfusion lesion volume of at least 50% between baseline and early follow-up. Good functional outcome was defined as a modified Rankin Scale score ≤2 at day 90. Lesion growth was defined as the difference between the baseline and the early follow-up diffusion-weighted imaging lesion volumes. RESULTS: Among 78 patients with the target mismatch profile (mean age 66 ± 16 years, 54% women), reperfusion was associated with increased odds of good functional outcome (adjusted odds ratio 3.7, 95% confidence interval 1.2-12, p = 0.03) and attenuation of lesion growth (p = 0.02). Time to treatment did not modify these effects (p value for the time × reperfusion interaction is 0.6 for good functional outcome and 0.3 for lesion growth). Similarly, in the subgroup of patients with reperfusion (n = 46), time to treatment was not associated with good functional outcome (p = 0.2). CONCLUSION: The association between endovascular reperfusion and improved functional and radiologic outcomes is not time-dependent in patients with a perfusion-diffusion mismatch. Proof that patients with mismatch benefit from endovascular therapy in the late time window should come from a randomized placebo-controlled trial.
Authors: Michael P Marks; Maarten G Lansberg; Michael Mlynash; Stephanie Kemp; Ryan A McTaggart; Greg Zaharchuk; Roland Bammer; Gregory W Albers Journal: Int J Stroke Date: 2014-03-31 Impact factor: 5.266
Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Randall T Higashida; Anthony J Furlan; Heidi Roberts; Thomas Tomsick; Buddy Connors; John Barr; William Dillon; Steven Warach; Joseph Broderick; Barbara Tilley; David Sacks Journal: Stroke Date: 2003-07-17 Impact factor: 7.914
Authors: C Leiva-Salinas; A Aghaebrahim; G Zhu; J T Patrie; W Xin; B C Lau; T Jovin; M Wintermark Journal: Neuroradiology Date: 2013-04-05 Impact factor: 2.804
Authors: G Marchal; V Beaudouin; P Rioux; V de la Sayette; F Le Doze; F Viader; J M Derlon; J C Baron Journal: Stroke Date: 1996-04 Impact factor: 7.914
Authors: Jeffrey L Saver; Mayank Goyal; Alain Bonafe; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; David J Cohen; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Thomas G Devlin; Demetrius K Lopes; Vivek Reddy; Richard du Mesnil de Rochemont; Reza Jahan Journal: Int J Stroke Date: 2015-04 Impact factor: 5.266
Authors: D Sacks; B Baxter; B C V Campbell; J S Carpenter; C Cognard; D Dippel; M Eesa; U Fischer; K Hausegger; J A Hirsch; M S Hussain; O Jansen; M V Jayaraman; A A Khalessi; B W Kluck; S Lavine; P M Meyers; S Ramee; D A Rüfenacht; C M Schirmer; D Vorwerk Journal: AJNR Am J Neuroradiol Date: 2018-05-17 Impact factor: 3.825
Authors: Gregory W Albers; Maarten G Lansberg; Stephanie Kemp; Jenny P Tsai; Phil Lavori; Soren Christensen; Michael Mlynash; Sun Kim; Scott Hamilton; Sharon D Yeatts; Yuko Palesch; Roland Bammer; Joe Broderick; Michael P Marks Journal: Int J Stroke Date: 2017-03-24 Impact factor: 5.266
Authors: Maarten G Lansberg; Soren Christensen; Stephanie Kemp; Michael Mlynash; Nishant Mishra; Christian Federau; Jenny P Tsai; Sun Kim; Raul G Nogueria; Tudor Jovin; Thomas G Devlin; Naveed Akhtar; Dileep R Yavagal; Diogo Haussen; Seena Dehkharghani; Roland Bammer; Matus Straka; Greg Zaharchuk; Michael P Marks; Gregory W Albers Journal: Ann Neurol Date: 2017-06-09 Impact factor: 10.422
Authors: S Dehkharghani; M Bowen; D C Haussen; T Gleason; A Prater; Q Cai; J Kang; R G Nogueira Journal: AJNR Am J Neuroradiol Date: 2016-10-06 Impact factor: 3.825
Authors: Maarten G Lansberg; Michael Mlynash; Scott Hamilton; Sharon D Yeatts; Soren Christensen; Stephanie Kemp; Philip W Lavori; Santiago Ortega-Gutierrez; Joe Broderick; Jeremy Heit; Michael P Marks; Gregory W Albers Journal: JAMA Neurol Date: 2019-04-01 Impact factor: 18.302