Sibu Mundiyanapurath1, Sascha Diatschuk2, Sarah Loebel3, Johannes Pfaff3, Mirko Pham4, Markus Alfred Möhlenbruch3, Wolfgang Wick5, Martin Bendszus3, Peter A Ringleb6, Alexander Radbruch7. 1. Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany. Electronic address: sibu.mundiyanapurath@med.uni-heidelberg.de. 2. German Cancer Research Centre, Department of Radiology, Heidelberg, Germany. 3. Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany. 4. Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany; Institute for Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Germany. 5. Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany; CCU Neurooncology, German Cancer Consortium (DKTK) & German Cancer Research Centre (DKFZ), Heidelberg, Germany. 6. Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany. 7. German Cancer Research Centre, Department of Radiology, Heidelberg, Germany; Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
Abstract
BACKGROUND AND PURPOSE: Patients with ischemic stroke and large vessel occlusion are assumed to benefit from endovascular therapy (ET) independent of the symptom onset-to-treatment time (OTT) if they present with a mismatch of diffusion- and perfusion-weighted imaging (DWI-PWI mismatch). We aimed at studying the influence of OTT on clinical outcome in these patients. METHODS: Retrospective database review in a tertiary care university hospital. All patients presented with proximal vessel occlusion of the anterior circulation and DWI-PWI mismatch. Primary outcome was the influence of OTT on modified Rankin scale (mRS) score three months after treatment, dichotomized in favourable (0-2) and unfavourable outcome (3-6). Secondary outcome was the effect of OTT on the shift of the mRS score. Patients treated within an early time window (<340min) and a late time window (≥340min) were compared. RESULTS: 139 patients were included. The rate of favourable outcome was significantly higher in patients who were treated in an early compared to those treated in a late time window (31 [49%] vs. 20 patients [27%], p=0.005). Adjusted multivariate logistic regression revealed that late treatment was an independent negative predictor of favourable outcome (odds ratio 0.39, confidence interval [0.18-0.84]; p=0.016). A shift towards higher mRS scores for late treatment was evident (p=0.015). In sensitivity analysis, OTT remained an independent predictor when evaluated as continuous variable. These findings were confirmed in patients with a comparable DWI-PWI mismatch according to the definitions from large trials (DEFUSE 2, DEFUSE 3, SWIFT-PRIME, EXTEND-IA). CONCLUSION: Outcome of patients with comparable DWI-PWI mismatch is time-dependent.
BACKGROUND AND PURPOSE:Patients with ischemic stroke and large vessel occlusion are assumed to benefit from endovascular therapy (ET) independent of the symptom onset-to-treatment time (OTT) if they present with a mismatch of diffusion- and perfusion-weighted imaging (DWI-PWI mismatch). We aimed at studying the influence of OTT on clinical outcome in these patients. METHODS: Retrospective database review in a tertiary care university hospital. All patients presented with proximal vessel occlusion of the anterior circulation and DWI-PWI mismatch. Primary outcome was the influence of OTT on modified Rankin scale (mRS) score three months after treatment, dichotomized in favourable (0-2) and unfavourable outcome (3-6). Secondary outcome was the effect of OTT on the shift of the mRS score. Patients treated within an early time window (<340min) and a late time window (≥340min) were compared. RESULTS: 139 patients were included. The rate of favourable outcome was significantly higher in patients who were treated in an early compared to those treated in a late time window (31 [49%] vs. 20 patients [27%], p=0.005). Adjusted multivariate logistic regression revealed that late treatment was an independent negative predictor of favourable outcome (odds ratio 0.39, confidence interval [0.18-0.84]; p=0.016). A shift towards higher mRS scores for late treatment was evident (p=0.015). In sensitivity analysis, OTT remained an independent predictor when evaluated as continuous variable. These findings were confirmed in patients with a comparable DWI-PWI mismatch according to the definitions from large trials (DEFUSE 2, DEFUSE 3, SWIFT-PRIME, EXTEND-IA). CONCLUSION: Outcome of patients with comparable DWI-PWI mismatch is time-dependent.
Authors: A Potreck; S Loebel; J Pfaff; L Østergaard; K Mouridsen; A Radbruch; M Bendszus; S Mundiyanapurath Journal: Eur Radiol Date: 2019-03-18 Impact factor: 5.315
Authors: Nikolaj Bøgh; Rie B Olin; Esben Ss Hansen; Jeremy W Gordon; Sabrina K Bech; Lotte B Bertelsen; Juan D Sánchez-Heredia; Jakob U Blicher; Leif Østergaard; Jan H Ardenkjær-Larsen; Robert A Bok; Daniel B Vigneron; Christoffer Laustsen Journal: J Cereb Blood Flow Metab Date: 2021-05-20 Impact factor: 6.200
Authors: Fatih Seker; Johannes Pfaff; Arne Potreck; Sibu Mundiyanapurath; Peter A Ringleb; Martin Bendszus; Markus A Möhlenbruch Journal: Brain Behav Date: 2017-07-26 Impact factor: 2.708