Chushuang Chen1, Mark W Parsons2, Christopher R Levi3,4, Neil J Spratt3,4, Longting Lin2, Timothy Kleinig5, Kenneth Butcher6, Xin Cheng7, Qiang Dong7, Billy O'Brien8, Richard I Avivi9, Martin Krause10, P N Sylaja11, Philip Choi12, Sandeep Bhuta13, Congguo Yin14, Jianhong Yang15, Peng Wang16, Weiwen Qiu17, Andrew Bivard1. 1. Melbourne Brain Centre, University of Melbourne, Parkville, VIC, Australia. 2. Department of Neurology, Liverpool Hospital, University of New South Wales, Sydney, NSW, Australia. 3. Department of Neurology, John Hunter Hospital, University of Newcastle, Callaghan, NSW, Australia. 4. Hunter Medical Research Institute, New Lambton Heights, NSW, Australia. 5. Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia. 6. Prince of Wales Medical School, University of New South Wales, Sydney, NSW, Australia. 7. Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China. 8. Department of Neurology, Gosford Hospital, Gosford, NSW, Australia. 9. Division of Neuroradiology, Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 10. Department of Neurology, Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia. 11. Department of Neurology, Sri Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India. 12. Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia. 13. Department of Medical Imaging, Gold Coast University Hospital, Southport, QLD, Australia. 14. Department of Neurology, Hangzhou First Hospital, Zhejiang, China. 15. Department of Neurology, Ningbo First Hospital, Zhejiang, China. 16. Department of Neurology, Taizhou First People's Hospital, Zhejiang, China. 17. Department of Neurology, Lishui People's Hospital, Zhejiang, China.
Abstract
We aimed to compare Perfusion Imaging Mismatch (PIM) and Clinical Core Mismatch (CCM) criteria in ischemic stroke patients to identify the effect of these criteria on selected patient population characteristics and clinical outcomes. Patients from the INternational Stroke Perfusion Imaging REgistry (INSPIRE) who received reperfusion therapy, had pre-treatment multimodal CT, 24-h imaging, and 3 month outcomes were analyzed. Patients were divided into 3 cohorts: endovascular thrombectomy (EVT), intravenous thrombolysis alone with large vessel occlusion (IVT-LVO), and intravenous thrombolysis alone without LVO (IVT-nonLVO). Patients were classified using 6 separate mismatch criteria: PIM-using 3 different measures to define the perfusion deficit (Delay Time, Tmax, or Mean Transit Time); or CCM-mismatch between age-adjusted National Institutes of Health Stroke Scale and CT Perfusion core, defined as relative cerebral blood flow <30% within the perfusion deficit defined in three ways (as above). We assessed the eligibility rate for each mismatch criterion and its ability to identify patients likely to respond to treatment. There were 994 patients eligible for this study. PIM with delay time (PIM-DT) had the highest inclusion rate for both EVT (82.7%) and IVT-LVO (79.5%) cohorts. In PIM positive patients who received EVT, recanalization was strongly associated with achieving an excellent outcome at 90-days (e.g., PIM-DT: mRS 0-1, adjusted OR 4.27, P = 0.005), whereas there was no such association between reperfusion and an excellent outcome with any of the CCM criteria (all p > 0.05). Notably, in IVT-LVO cohort, 58.2% of the PIM-DT positive patients achieved an excellent outcome compared with 31.0% in non-mismatch patients following successful recanalization (P = 0.006). Conclusion: PIM-DT was the optimal mismatch criterion in large vessel occlusion patients, combining a high eligibility rate with better clinical response to reperfusion. No mismatch criterion was useful to identify patients who are most likely response to reperfusion in non-large vessel occlusion patients.
We aimed to compare Perfusion Imaging Mismatch (PIM) and Clinical Core Mismatch (CCM) criteria in ischemic strokepatients to identify the effect of these criteria on selected patient population characteristics and clinical outcomes. Patients from the INternational Stroke Perfusion Imaging REgistry (INSPIRE) who received reperfusion therapy, had pre-treatment multimodal CT, 24-h imaging, and 3 month outcomes were analyzed. Patients were divided into 3 cohorts: endovascular thrombectomy (EVT), intravenous thrombolysis alone with large vessel occlusion (IVT-LVO), and intravenous thrombolysis alone without LVO (IVT-nonLVO). Patients were classified using 6 separate mismatch criteria: PIM-using 3 different measures to define the perfusion deficit (Delay Time, Tmax, or Mean Transit Time); or CCM-mismatch between age-adjusted National Institutes of Health Stroke Scale and CT Perfusion core, defined as relative cerebral blood flow <30% within the perfusion deficit defined in three ways (as above). We assessed the eligibility rate for each mismatch criterion and its ability to identify patients likely to respond to treatment. There were 994 patients eligible for this study. PIM with delay time (PIM-DT) had the highest inclusion rate for both EVT (82.7%) and IVT-LVO (79.5%) cohorts. In PIM positive patients who received EVT, recanalization was strongly associated with achieving an excellent outcome at 90-days (e.g., PIM-DT: mRS 0-1, adjusted OR 4.27, P = 0.005), whereas there was no such association between reperfusion and an excellent outcome with any of the CCM criteria (all p > 0.05). Notably, in IVT-LVO cohort, 58.2% of the PIM-DT positive patients achieved an excellent outcome compared with 31.0% in non-mismatch patients following successful recanalization (P = 0.006). Conclusion:PIM-DT was the optimal mismatch criterion in large vessel occlusion patients, combining a high eligibility rate with better clinical response to reperfusion. No mismatch criterion was useful to identify patients who are most likely response to reperfusion in non-large vessel occlusion patients.
Authors: Chushuang Chen; Andrew Bivard; Longting Lin; Christopher R Levi; Neil J Spratt; Mark W Parsons Journal: J Cereb Blood Flow Metab Date: 2017-11-27 Impact factor: 6.200
Authors: Gregory W Albers; Michael P Marks; Stephanie Kemp; Soren Christensen; Jenny P Tsai; Santiago Ortega-Gutierrez; Ryan A McTaggart; Michel T Torbey; May Kim-Tenser; Thabele Leslie-Mazwi; Amrou Sarraj; Scott E Kasner; Sameer A Ansari; Sharon D Yeatts; Scott Hamilton; Michael Mlynash; Jeremy J Heit; Greg Zaharchuk; Sun Kim; Janice Carrozzella; Yuko Y Palesch; Andrew M Demchuk; Roland Bammer; Philip W Lavori; Joseph P Broderick; Maarten G Lansberg Journal: N Engl J Med Date: 2018-01-24 Impact factor: 91.245
Authors: Huiqiao Tian; Mark W Parsons; Christopher R Levi; Longting Lin; Richard I Aviv; Neil J Spratt; Kenneth S Butcher; Min Lou; Timothy J Kleinig; Andrew Bivard Journal: Neurology Date: 2019-05-01 Impact factor: 9.910
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: Henry Ma; Bruce C V Campbell; Mark W Parsons; Leonid Churilov; Christopher R Levi; Chung Hsu; Timothy J Kleinig; Tissa Wijeratne; Sami Curtze; Helen M Dewey; Ferdinand Miteff; Chon-Haw Tsai; Jiunn-Tay Lee; Thanh G Phan; Neil Mahant; Mu-Chien Sun; Martin Krause; Jonathan Sturm; Rohan Grimley; Chih-Hung Chen; Chaur-Jong Hu; Andrew A Wong; Deborah Field; Yu Sun; P Alan Barber; Arman Sabet; Jim Jannes; Jiann-Shing Jeng; Benjamin Clissold; Romesh Markus; Ching-Huang Lin; Li-Ming Lien; Christopher F Bladin; Søren Christensen; Nawaf Yassi; Gagan Sharma; Andrew Bivard; Patricia M Desmond; Bernard Yan; Peter J Mitchell; Vincent Thijs; Leeanne Carey; Atte Meretoja; Stephen M Davis; Geoffrey A Donnan Journal: N Engl J Med Date: 2019-05-09 Impact factor: 91.245
Authors: Max Wintermark; Gregory W Albers; Joseph P Broderick; Andrew M Demchuk; Jochen B Fiebach; Jens Fiehler; James C Grotta; Gary Houser; Tudor G Jovin; Kennedy R Lees; Michael H Lev; David S Liebeskind; Marie Luby; Keith W Muir; Mark W Parsons; Rüdiger von Kummer; Joanna M Wardlaw; Ona Wu; Albert J Yoo; Andrei V Alexandrov; Jeffry R Alger; Richard I Aviv; Roland Bammer; Jean-Claude Baron; Fernando Calamante; Bruce C V Campbell; Trevor C Carpenter; Søren Christensen; William A Copen; Colin P Derdeyn; E Clarke Haley; Pooja Khatri; Kohsuke Kudo; Maarten G Lansberg; Lawrence L Latour; Ting-Yim Lee; Richard Leigh; Weili Lin; Patrick Lyden; Grant Mair; Bijoy K Menon; Patrik Michel; Robert Mikulik; Raul G Nogueira; Leif Ostergaard; Salvador Pedraza; Christian H Riedel; Howard A Rowley; Pina C Sanelli; Makoto Sasaki; Jeffrey L Saver; Pamela W Schaefer; Peter D Schellinger; Georgios Tsivgoulis; Lawrence R Wechsler; Philip M White; Greg Zaharchuk; Osama O Zaidat; Stephen M Davis; Geoffrey A Donnan; Anthony J Furlan; Werner Hacke; Dong-Wha Kang; Chelsea Kidwell; Vincent N Thijs; Götz Thomalla; Steven J Warach Journal: Stroke Date: 2013-07-16 Impact factor: 7.914
Authors: Huiqiao Tian; Mark W Parsons; Christopher R Levi; Xin Cheng; Richard I Aviv; Neil J Spratt; Timothy J Kleinig; Billy O'Brien; Kenneth S Butcher; Longting Lin; Jingfen Zhang; Qiang Dong; Chushuang Chen; Andrew Bivard Journal: Front Neurol Date: 2018-06-06 Impact factor: 4.003