Jordi Borst1, Olvert A Berkhemer2, Yvo B W E M Roos2, Ed van Bavel2, Wim H van Zwam2, Robert J van Oostenbrugge2, Marianne A A van Walderveen2, Hester F Lingsma2, Aad van der Lugt2, Diederik W J Dippel2, Albert J Yoo2, Henk A Marquering2, Charles B L M Majoie2. 1. From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.). j.borst@amc.uva.nl. 2. From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
Abstract
BACKGROUND AND PURPOSE: The utility of computed tomographic perfusion (CTP)-based patient selection for intra-arterial treatment of acute ischemic stroke has not been proven in randomized trials and requires further study in a cohort that was not selected based on CTP. Our objective was to study the relationship between CTP-derived parameters and outcome and treatment effect in patients with acute ischemic stroke because of a proximal intracranial arterial occlusion. METHODS: We included 175 patients who underwentCTP in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN). Association of CTP-derived parameters (ischemic-core volume, penumbra volume, and percentage ischemic core) with outcome was estimated with multivariable ordinal logistic regression as an adjusted odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale. Interaction between CTP-derived parameters and treatment effect was determined using multivariable ordinal logistic regression. Interaction with treatment effect was also tested for mismatch (core <70 mL; penumbra core >1.2; penumbra core >10 mL). RESULTS: The adjusted odds ratio for improved functional outcome for ischemic core, percentage ischemic core, and penumbra were 0.79 per 10 mL (95% confidence interval: 0.71-0.89; P<0.001), 0.82 per 10% (95% confidence interval: 0.66-0.90; P=0.002), and 0.97 per 10 mL (96% confidence interval: 0.92-1.01; P=0.15), respectively. No significant interaction between any of the CTP-derived parameters and treatment effect was observed. We observed no significant interaction between mismatch and treatment effect. CONCLUSIONS:CTP seems useful for predicting functional outcome, but cannot reliably identify patients who will not benefit from intra-arterial therapy.
RCT Entities:
BACKGROUND AND PURPOSE: The utility of computed tomographic perfusion (CTP)-based patient selection for intra-arterial treatment of acute ischemic stroke has not been proven in randomized trials and requires further study in a cohort that was not selected based on CTP. Our objective was to study the relationship between CTP-derived parameters and outcome and treatment effect in patients with acute ischemic stroke because of a proximal intracranial arterial occlusion. METHODS: We included 175 patients who underwent CTP in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN). Association of CTP-derived parameters (ischemic-core volume, penumbra volume, and percentage ischemic core) with outcome was estimated with multivariable ordinal logistic regression as an adjusted odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale. Interaction between CTP-derived parameters and treatment effect was determined using multivariable ordinal logistic regression. Interaction with treatment effect was also tested for mismatch (core <70 mL; penumbra core >1.2; penumbra core >10 mL). RESULTS: The adjusted odds ratio for improved functional outcome for ischemic core, percentage ischemic core, and penumbra were 0.79 per 10 mL (95% confidence interval: 0.71-0.89; P<0.001), 0.82 per 10% (95% confidence interval: 0.66-0.90; P=0.002), and 0.97 per 10 mL (96% confidence interval: 0.92-1.01; P=0.15), respectively. No significant interaction between any of the CTP-derived parameters and treatment effect was observed. We observed no significant interaction between mismatch and treatment effect. CONCLUSIONS:CTP seems useful for predicting functional outcome, but cannot reliably identify patients who will not benefit from intra-arterial therapy.
Authors: Thoralf Thamm; Jia Guo; Jarrett Rosenberg; Tie Liang; Michael P Marks; Soren Christensen; Huy M Do; Stephanie M Kemp; Emma Adair; Irina Eyngorn; Michael Mlynash; Tudor G Jovin; Bart P Keogh; Hui J Chen; Maarten G Lansberg; Gregory W Albers; Greg Zaharchuk Journal: Stroke Date: 2019-10-17 Impact factor: 7.914
Authors: Jens Fiehler; Christophe Cognard; Mauro Gallitelli; Olav Jansen; Adam Kobayashi; Heinrich P Mattle; Keith W Muir; Mikael Mazighi; Karl Schaller; Peter D Schellinger Journal: Eur Stroke J Date: 2016-07-26
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: 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: Pan Su; Hongli Fan; Peiying Liu; Yang Li; Ye Qiao; Jun Hua; Doris Lin; Dengrong Jiang; Jay J Pillai; Argye E Hillis; Hanzhang Lu Journal: NMR Biomed Date: 2019-11-04 Impact factor: 4.044
Authors: I R van den Wijngaard; G Holswilder; M J H Wermer; J Boiten; A Algra; D W J Dippel; J W Dankbaar; B K Velthuis; A M M Boers; C B L M Majoie; M A A van Walderveen Journal: AJNR Am J Neuroradiol Date: 2016-03-31 Impact factor: 3.825
Authors: Won Hyung A Ryu; Michael B Avery; Navjit Dharampal; Isabel E Allen; Steven W Hetts Journal: J Neurointerv Surg Date: 2016-11-09 Impact factor: 5.836
Authors: Steven J Warach; Marie Luby; Gregory W Albers; Roland Bammer; Andrew Bivard; Bruce C V Campbell; Colin Derdeyn; Jeremy J Heit; Pooja Khatri; Maarten G Lansberg; David S Liebeskind; Charles B L M Majoie; Michael P Marks; Bijoy K Menon; Keith W Muir; Mark W Parsons; Achala Vagal; Albert J Yoo; Andrei V Alexandrov; Jean-Claude Baron; David J Fiorella; Anthony J Furlan; Josep Puig; Peter D Schellinger; Max Wintermark Journal: Stroke Date: 2016-04-12 Impact factor: 7.914