Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue.

Details

Serval ID
serval:BIB_4C6ECBF93D22
Type
Article: article from journal or magazin.
Collection
Publications
Title
Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue.
Journal
Neurology
Author(s)
Lansberg M.G., Cereda C.W., Mlynash M., Mishra N.K., Inoue M., Kemp S., Christensen S., Straka M., Zaharchuk G., Marks M.P., Bammer R., Albers G.W., Diffusion 
Working group(s)
Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) Study Investigators
Contributor(s)
Diffusion , Saver J., Fayad P., Howard G., Tomsick T., Jovin T., Wechsler L., DeCesare S., Thai D., Sherr A., Wilder M., Tricot A., Lutsep H., McDaneld L., Larsen D., Czartoski T., Keogh B., Malik AM., Brown A., Bernstein R., Muskovich K., Chang C., Stern T., Warach S., Davis L., Fazekas F., Seifert-Held T.
ISSN
1526-632X (Electronic)
ISSN-L
0028-3878
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
85
Number
8
Pages
708-714
Language
english
Abstract
OBJECTIVE: To evaluate whether time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on MRI.
METHODS: Patients from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) cohort study with a perfusion-diffusion target mismatch were included. Reperfusion was defined as a decrease in the perfusion lesion volume of at least 50% between baseline and early follow-up. Good functional outcome was defined as a modified Rankin Scale score ≤2 at day 90. Lesion growth was defined as the difference between the baseline and the early follow-up diffusion-weighted imaging lesion volumes.
RESULTS: Among 78 patients with the target mismatch profile (mean age 66 ± 16 years, 54% women), reperfusion was associated with increased odds of good functional outcome (adjusted odds ratio 3.7, 95% confidence interval 1.2-12, p = 0.03) and attenuation of lesion growth (p = 0.02). Time to treatment did not modify these effects (p value for the time × reperfusion interaction is 0.6 for good functional outcome and 0.3 for lesion growth). Similarly, in the subgroup of patients with reperfusion (n = 46), time to treatment was not associated with good functional outcome (p = 0.2).
CONCLUSION: The association between endovascular reperfusion and improved functional and radiologic outcomes is not time-dependent in patients with a perfusion-diffusion mismatch. Proof that patients with mismatch benefit from endovascular therapy in the late time window should come from a randomized placebo-controlled trial.
Keywords
Aged, Aged, 80 and over, Cerebrovascular Circulation/physiology, Endovascular Procedures/standards, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Outcome Assessment (Health Care), Reperfusion/standards, Stroke/pathology, Stroke/therapy, Time Factors
Pubmed
Create date
16/03/2016 18:09
Last modification date
20/08/2019 14:00
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