Marc D Gilgen1, Dariusz Klimek1, Kai T Liesirova1, Julia Meisterernst1, Pascal P Klinger-Gratz1, Gerhard Schroth2, Pasquale Mordasini1, Kety Hsieh1, Johannes Slotboom1, Mirjam R Heldner1, Anne Broeg-Morvay1, Marie-Luise Mono1, Urs Fischer1, Heinrich P Mattle1, Marcel Arnold1, Jan Gralla1, Marwan El-Koussy1, Simon Jung1. 1. From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.). 2. From the Department of Diagnostic and Interventional Neuroradiology (M.D.G., D.K., P.P.K.-G., G.S., P.M., K.H., J.S., J.G., M.E.-K., S.J.) and Department of Neurology, Inselspital (M.D.G., K.T.L., J.M., M.R.H., A.B.-M., M.-L.M., U.F., H.P.M., M.A., S.J.), University Hospital Bern and University of Bern, Bern, Switzerland; and Department of Radiology, University of Basel, Basel (P.P.K.-G.). gerhard.schroth@insel.ch.
Abstract
BACKGROUND AND PURPOSE: Lesion volume on diffusion-weighted magnetic resonance imaging (DWI) before acute stroke therapy is a predictor of outcome. Therefore, patients with large volumes are often excluded from therapy. The aim of this study was to analyze the impact of endovascular treatment in patients with large DWI lesion volumes (>70 mL). METHODS: Three hundred seventy-two patients with middle cerebral or internal carotid artery occlusions examined with magnetic resonance imaging before treatment since 2004 were included. Baseline data and 3 months outcome were recorded prospectively. DWI lesion volumes were measured semiautomatically. RESULTS: One hundred five patients had lesions >70 mL. Overall, the volume of DWI lesions was an independent predictor of unfavorable outcome, survival, and symptomatic intracerebral hemorrhage (P<0.001 each). In patients with DWI lesions >70 mL, 11 of 31 (35.5%) reached favorable outcome (modified Rankin scale score, 0-2) after thrombolysis in cerebral infarction 2b-3 reperfusion in contrast to 3 of 35 (8.6%) after thrombolysis in cerebral infarction 0-2a reperfusion (P=0.014). Reperfusion success, patient age, and DWI lesion volume were independent predictors of outcome in patients with DWI lesions >70 mL. Thirteen of 66 (19.7%) patients with lesions >70 mL had symptomatic intracerebral hemorrhage with a trend for reduced risk with avoidance of thrombolytic agents. CONCLUSIONS: There was a growing risk for poor outcome and symptomatic intracerebral hemorrhage with increasing pretreatment DWI lesion volumes. Nevertheless, favorable outcome was achieved in every third patient with DWI lesions >70 mL after successful endovascular reperfusion, whereas after poor or failed reperfusion, outcome was favorable in only every 12th patient. Therefore, endovascular treatment might be considered in patients with large DWI lesions, especially in younger patients.
BACKGROUND AND PURPOSE: Lesion volume on diffusion-weighted magnetic resonance imaging (DWI) before acute stroke therapy is a predictor of outcome. Therefore, patients with large volumes are often excluded from therapy. The aim of this study was to analyze the impact of endovascular treatment in patients with large DWI lesion volumes (>70 mL). METHODS: Three hundred seventy-two patients with middle cerebral or internal carotid artery occlusions examined with magnetic resonance imaging before treatment since 2004 were included. Baseline data and 3 months outcome were recorded prospectively. DWI lesion volumes were measured semiautomatically. RESULTS: One hundred five patients had lesions >70 mL. Overall, the volume of DWI lesions was an independent predictor of unfavorable outcome, survival, and symptomatic intracerebral hemorrhage (P<0.001 each). In patients with DWI lesions >70 mL, 11 of 31 (35.5%) reached favorable outcome (modified Rankin scale score, 0-2) after thrombolysis in cerebral infarction 2b-3 reperfusion in contrast to 3 of 35 (8.6%) after thrombolysis in cerebral infarction 0-2a reperfusion (P=0.014). Reperfusion success, patient age, and DWI lesion volume were independent predictors of outcome in patients with DWI lesions >70 mL. Thirteen of 66 (19.7%) patients with lesions >70 mL had symptomatic intracerebral hemorrhage with a trend for reduced risk with avoidance of thrombolytic agents. CONCLUSIONS: There was a growing risk for poor outcome and symptomatic intracerebral hemorrhage with increasing pretreatment DWI lesion volumes. Nevertheless, favorable outcome was achieved in every third patient with DWI lesions >70 mL after successful endovascular reperfusion, whereas after poor or failed reperfusion, outcome was favorable in only every 12th patient. Therefore, endovascular treatment might be considered in patients with large DWI lesions, especially in younger patients.
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: Melissa S Eng; Anand V Patel; Richard B Libman; Paul Wright; Jeffrey M Katz Journal: Curr Atheroscler Rep Date: 2017-10-24 Impact factor: 5.113
Authors: Feras Akbik; Joshua A Hirsch; Pedro Telles Cougo-Pinto; Ronil V Chandra; Claus Z Simonsen; Thabele Leslie-Mazwi Journal: Curr Treat Options Cardiovasc Med Date: 2016-05
Authors: Bhavya Rehani; Simon G Ammanuel; Yi Zhang; Wade Smith; Daniel L Cooke; Steven W Hetts; S Andrew Josephson; Anthony Kim; J Claude Hemphill; William Dillon Journal: Neurohospitalist Date: 2019-08-19
Authors: Gregoire Boulouis; Arne Lauer; Ahmer Khawdja Siddiqui; Andreas Charidimou; Robert W Regenhardt; Anand Viswanathan; Natalia Rost; Thabele M Leslie-Mazwi; Lee H Schwamm Journal: JAMA Neurol Date: 2017-11-01 Impact factor: 18.302