Perfusion Imaging and Clinical Outcome in Acute Minor Stroke With Large Vessel Occlusion.

Details

Serval ID
serval:BIB_1AECD602B2AF
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Perfusion Imaging and Clinical Outcome in Acute Minor Stroke With Large Vessel Occlusion.
Journal
Stroke
Author(s)
Seners P., Arquizan C., Fontaine L., Ben Hassen W., Heldner M.R., Strambo D., Nagel S., Carrera E., Mechtouff L., McCullough-Hicks M., Mohammaden M.H., Cottier J.P., Henon H., Aignatoaie A., Laksiri N., Papassin J., Lucas L., Garnier P., Triquenot A., Mione G., Hajdu S., Costalat V., Potreck A., Detante O., Bonneville F., Berthezene Y., Bracard S., Sibon I., Bricout N., Boutet C., Mordasini P., Michel P., Oppenheim C., Olivot J.M., Nogueira R.G., Albers G.W., Baron J.C., Turc G.
Working group(s)
MINOR-STROKE-Perfusion Collaborators
Contributor(s)
Cognard C., Marnat G., Menegon P., Ledure S., Dargazanli C., Cho T.H., Nighoghossian N., Eker O., Gouttard S., Haussen D., Debiais S., Charron V., Charron N., Leys D., Ozsancak C., Delpech M., Brunel H., Papagiannaki C., Girardin E., Richard S., Gory B., Zbinden M., Dobrocky T., Ringelb P., Möhlenbruch M.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
11/2022
Peer-reviewed
Oui
Volume
53
Number
11
Pages
3429-3438
Language
english
Notes
Publication types: Observational Study ; Multicenter Study ; Journal Article
Publication Status: ppublish
Abstract
Whether bridging therapy (intravenous thrombolysis [IVT] followed by mechanical thrombectomy) is superior to IVT alone in minor stroke with large vessel occlusion is unknown. Perfusion imaging may identify subsets of large vessel occlusion-related minor stroke patients with distinct response to bridging therapy.
We conducted a multicenter international observational study of consecutive IVT-treated patients with minor stroke (National Institutes of Health Stroke Scale score ≤5) who had an anterior circulation large vessel occlusion and perfusion imaging performed before IVT, with a subset undergoing immediate thrombectomy. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month modified Rankin Scale score 0 to 1. We searched for an interaction between treatment group and mismatch volume (critical hypoperfusion-core volume).
Overall, 569 patients were included (172 and 397 in the bridging therapy and IVT groups, respectively). After propensity-score weighting, the distribution of baseline variables was similar across the 2 groups. In the entire population, bridging was associated with lower odds of achieving modified Rankin Scale score 0 to 1: odds ratio, 0.73 [95% CI, 0.55-0.96]; P=0.03. However, mismatch volume modified the effect of bridging on clinical outcome (P <sub>interaction</sub> =0.04 for continuous mismatch volume); bridging was associated with worse outcome in patients with, but not in those without, mismatch volume <40 mL (odds ratio, [95% CI] for modified Rankin Scale score 0-1: 0.48 [0.33-0.71] versus 1.14 [0.76-1.71], respectively). Bridging was associated with higher incidence of symptomatic intracranial hemorrhage in the entire population, but this effect was present in the small mismatch subset only (P <sub>interaction</sub> =0.002).
In our population of large vessel occlusion-related minor stroke patients, bridging therapy was associated with lower rates of good outcome as compared with IVT alone. However, mismatch volume was a strong modifier of the effect of bridging therapy over IVT alone, notably with worse outcome with bridging therapy in patients with mismatch volume ≤40 mL. Randomized trials should consider adding perfusion imaging for patient selection.
Keywords
Humans, Brain Ischemia/diagnostic imaging, Brain Ischemia/therapy, Brain Ischemia/complications, Treatment Outcome, Stroke/therapy, Stroke/drug therapy, Thrombectomy/methods, Perfusion Imaging, Arterial Occlusive Diseases/complications, Thrombolytic Therapy/methods, Fibrinolytic Agents/therapeutic use, incidence, odds ratio, perfusion imaging, propensity score, thrombectomy
Pubmed
Create date
03/08/2022 9:02
Last modification date
08/11/2022 6:38
Usage data