Multivariate dynamic prediction of ischemic infarction and tissue salvage as a function of time and degree of recanalization.

Autor:	Kemmling A; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Department of Clinical Radiology, University of Muenster, Muenster, Germany.; Institute of Neuroradiology, University Medical Center Schleswig Holstein, Lübeck, Germany., Flottmann F; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Forkert ND; Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada., Minnerup J; Department of Neurology, University of Muenster, Muenster, Germany., Heindel W; Department of Clinical Radiology, University of Muenster, Muenster, Germany., Thomalla G; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Eckert B; Department of Neuroradiology, Asklepios Hospital Altona, Hamburg, Germany., Knauth M; Department of Neuroradiology, University of Medicine Goettingen, Goettingen, Germany., Psychogios M; Department of Neuroradiology, University of Medicine Goettingen, Goettingen, Germany., Langner S; Institute of Diagnostic Radiology and Neuroradiology, University of Medicine Greifswald, Greifswald, Germany., Fiehler J; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Jazyk:	angličtina
Zdroj:	Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism [J Cereb Blood Flow Metab] 2015 Sep; Vol. 35 (9), pp. 1397-405. Date of Electronic Publication: 2015 Jul 08.
DOI:	10.1038/jcbfm.2015.144
Abstrakt:	Benefit of endovascular recanalization beyond established treatment time windows likely exists in select stroke patients. However, there is currently no imaging model that predicts infarction adjusting for elapsed time between the pathologic snapshot of admission imaging until endovascular recanalization. We trained and cross validated a multivariate generalized linear model (GLM) that uses computer tomography perfusion and clinical data to quantify patient-specific dynamic change of tissue infarction depending on degree and time of recanalization. Multicenter data of 161 patients with proximal anterior circulation occlusion undergoing endovascular therapy were included. Multivariate voxelwise infarct probability was calculated within the GLM. The effect of increasing time to treatment and degree of recanalization on voxelwise infarction was calculated in each patient. Tissue benefit of successful relative to unsuccessful recanalization was shown up to 15 hours after onset in individual patients and decreased nonlinearly with time. On average, the relative reduction of infarct volume at the treatment interval of 5 hours was 53% and this salvage effect decreased by 5% units per hour to <5% after 10 additional hours to treatment. Treatment time-adjusted multivariate prediction of infarction by perfusion and clinical status may identify patients who benefit from extended time to recanalization therapy.
Databáze:	MEDLINE
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