Jenny P Tsai1, Michael Mlynash2, Soren Christensen2, Stephanie Kemp2, Sun Kim2, Nishant K Mishra2, Christian Federau2, Raul G Nogueira2, Tudor G Jovin2, Thomas G Devlin2, Naveed Akhtar2, Dileep R Yavagal2, Roland Bammer2, Matus Straka2, Gregory Zaharchuk2, Michael P Marks2, Gregory W Albers2, Maarten G Lansberg2. 1. From the Department of Neurology (J.P.T., M.M., S.C., S. Kemp, S. Kim, N.M., C.F., M.S., G.W.A., M.G.L.) and Department of Radiology (R.B., G.Z., M.P.M.), Stanford University, CA; Department of Neurology, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology, University of Tennessee College of Medicine, Memphis (T.G.D.); Department of Radiology, Saint Luke's Health System, Kansas City, MO (N.A.); and Department of Neurology, University of Miami, FL (D.R.Y.). tsaij@ccf.org. 2. From the Department of Neurology (J.P.T., M.M., S.C., S. Kemp, S. Kim, N.M., C.F., M.S., G.W.A., M.G.L.) and Department of Radiology (R.B., G.Z., M.P.M.), Stanford University, CA; Department of Neurology, Emory University, Atlanta, GA (R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology, University of Tennessee College of Medicine, Memphis (T.G.D.); Department of Radiology, Saint Luke's Health System, Kansas City, MO (N.A.); and Department of Neurology, University of Miami, FL (D.R.Y.).
Abstract
BACKGROUND AND PURPOSE: This study aims to describe the relationship between computed tomographic (CT) perfusion (CTP)-to-reperfusion time and clinical and radiological outcomes, in a cohort of patients who achieve successful reperfusion for acute ischemic stroke. METHODS: We included data from the CRISP (Computed Tomographic Perfusion to Predict Response in Ischemic Stroke Project) in which all patients underwent a baseline CTP scan before endovascular therapy. Patients were included if they had a mismatch on their baseline CTP scan and achieved successful endovascular reperfusion. Patients with mismatch were categorized into target mismatch and malignant mismatch profiles, according to the volume of their Tmax >10s lesion volume (target mismatch, <100 mL; malignant mismatch, >100 mL). We investigated the impact of CTP-to-reperfusion times on probability of achieving functional independence (modified Rankin Scale, 0-2) at day 90 and radiographic outcomes at day 5. RESULTS: Of 156 included patients, 108 (59%) had the target mismatch profile, and 48 (26%) had the malignant mismatch profile. In patients with the target mismatch profile, CTP-to-reperfusion time showed no association with functional independence (P=0.84), whereas in patients with malignant mismatch profile, CTP-to-reperfusion time was strongly associated with lower probability of functional independence (odds ratio, 0.08; P=0.003). Compared with patients with target mismatch, those with the malignant mismatch profile had significantly more infarct growth (90 [49-166] versus 43 [18-81] mL; P=0.006) and larger final infarct volumes (110 [61-155] versus 48 [21-99] mL; P=0.001). CONCLUSIONS: Compared with target mismatch patients, those with the malignant profile experience faster infarct growth and a steeper decline in the odds of functional independence, with longer delays between baseline imaging and reperfusion. However, this does not exclude the possibility of treatment benefit in patients with a malignant profile.
BACKGROUND AND PURPOSE: This study aims to describe the relationship between computed tomographic (CT) perfusion (CTP)-to-reperfusion time and clinical and radiological outcomes, in a cohort of patients who achieve successful reperfusion for acute ischemic stroke. METHODS: We included data from the CRISP (Computed Tomographic Perfusion to Predict Response in Ischemic Stroke Project) in which all patients underwent a baseline CTP scan before endovascular therapy. Patients were included if they had a mismatch on their baseline CTP scan and achieved successful endovascular reperfusion. Patients with mismatch were categorized into target mismatch and malignant mismatch profiles, according to the volume of their Tmax >10s lesion volume (target mismatch, <100 mL; malignant mismatch, >100 mL). We investigated the impact of CTP-to-reperfusion times on probability of achieving functional independence (modified Rankin Scale, 0-2) at day 90 and radiographic outcomes at day 5. RESULTS: Of 156 included patients, 108 (59%) had the target mismatch profile, and 48 (26%) had the malignant mismatch profile. In patients with the target mismatch profile, CTP-to-reperfusion time showed no association with functional independence (P=0.84), whereas in patients with malignant mismatch profile, CTP-to-reperfusion time was strongly associated with lower probability of functional independence (odds ratio, 0.08; P=0.003). Compared with patients with target mismatch, those with the malignant mismatch profile had significantly more infarct growth (90 [49-166] versus 43 [18-81] mL; P=0.006) and larger final infarct volumes (110 [61-155] versus 48 [21-99] mL; P=0.001). CONCLUSIONS: Compared with target mismatch patients, those with the malignant profile experience faster infarct growth and a steeper decline in the odds of functional independence, with longer delays between baseline imaging and reperfusion. However, this does not exclude the possibility of treatment benefit in patients with a malignant profile.
Authors: Carlo W Cereda; Søren Christensen; Bruce C V Campbell; Nishant K Mishra; Michael Mlynash; Christopher Levi; Matus Straka; Max Wintermark; Roland Bammer; Gregory W Albers; Mark W Parsons; Maarten G Lansberg Journal: J Cereb Blood Flow Metab Date: 2015-10-19 Impact factor: 6.200
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