Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy

Autor: François Zhu, Aymeric Rouchaud, Wagih Benhassen, Joseph Benzakoun, Kevin Janot, Jean François Hak, Florent Gariel, Lili Detraz, Gaultier Marnat, Cyril Dargazanli, Gregoire Boulouis, Charline Perot, Basile Kerleroux, Romain Bourcier, Géraud Forestier, Dimitri Daly-Eraya, Johannes Kaesmacher, Pasquale Mordasini, Benjamin Gory
Přispěvatelé: Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Gui de Chauliac, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital de la Timone [CHU - APHM] (TIMONE), Aix Marseille Université (AMU), Hôpital Guillaume-et-René-Laennec [Saint-Herblain], CHU Limoges, Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Bern University Hospital [Berne] (Inselspital), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Martinez Rico, Clara
Jazyk: angličtina
Rok vydání: 2020
Předmět:
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
[SDV]Life Sciences [q-bio]
610 Medicine & health
Perfusion scanning
03 medical and health sciences
0302 clinical medicine
Modified Rankin Scale
Internal medicine
Medicine
Acute stroke
Endovascular treatment
030212 general & internal medicine
Prospective cohort study
Thrombectomy
[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology
Ischemic stroke
medicine.diagnostic_test
business.industry
Magnetic resonance imaging
Odds ratio
Perfusion imaging
Confidence interval
[SDV] Life Sciences [q-bio]
lcsh:RC666-701
Cardiology
Original Article
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
Perfusion
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
030217 neurology & neurosurgery
Cohort study
Zdroj: Journal of Stroke
Journal of Stroke, Vol 22, Iss 2, Pp 225-233 (2020)
Journal of Stroke, Korean Stroke Society, 2020, 22 (2), pp.225-233. ⟨10.5853/jos.2019.02908⟩
Journal of Stroke, 2020, 22 (2), pp.225-233. ⟨10.5853/jos.2019.02908⟩
Kerleroux, Basile; Janot, Kevin; Dargazanli, Cyril; Daly-Eraya, Dimitri; Ben-Hassen, Wagih; Zhu, François; Gory, Benjamin; Hak, Jean François; Perot, Charline; Detraz, Lili; Bourcier, Romain; Rouchaud, Aymeric; Forestier, Géraud; Benzakoun, Joseph; Marnat, Gaultier; Gariel, Florent; Mordasini, Pasquale; Kaesmacher, Johannes; Boulouis, Gregóire (2020). Perfusion Imaging to select patients with large ischemic core for mechanical thrombectomy. Journal of stroke, 22(2), pp. 225-233. Korean Stroke Society 10.5853/jos.2019.02908
ISSN: 2287-6405
2287-6391
Popis: Background and Purpose Patients with acute ischemic stroke, proximal vessel occlusion and a large ischemic core at presentation are commonly not considered for mechanical thrombectomy (MT). We tested the hypothesis that in patients with baseline large infarct cores, identification of remaining penumbral tissue using perfusion imaging would translate to better outcomes after MT.Methods This was a multicenter, retrospective, core lab adjudicated, cohort study of adult patients with proximal vessel occlusion, a large ischemic core volume (diffusion weighted imaging volume ≥70 mL), with pre-treatment magnetic resonance imaging perfusion, treated with MT (2015 to 2018) or medical care alone (controls; before 2015). Primary outcome measure was 3-month favorable outcome (defined as a modified Rankin Scale of 0–3). Core perfusion mismatch ratio (CPMR) was defined as the volume of critically hypo-perfused tissue (Tmax >6 seconds) divided by the core volume. Multivariable logistic regression models were used to determine factors that were independently associated with clinical outcomes. Outputs are displayed as adjusted odds ratio (aOR) and 95% confidence interval (CI).Results A total of 172 patients were included (MT n=130; Control n=42; mean age 69.0±15.4 years; 36% females). Mean core-volume and CPMR were 102.3±36.7 and 1.8±0.7 mL, respectively. As hypothesized, receiving MT was associated with increased probability of favorable outcome and functional independence, as CPMR increased, a difference becoming statistically significant above a mismatch-ratio of 1.72. Similarly, receiving MT was also associated with favorable outcome in the subgroup of 74 patients with CPMR >1.7 (aOR, 8.12; 95% CI, 1.24 to 53.11; P=0.028). Overall (prior to stratification by CPMR) 73 (42.4%) patients had a favorable outcome at 3 months, with no difference amongst groups.Conclusions In patients currently deemed ineligible for MT due to large infarct ischemic cores at baseline, CPMR identifies a subgroup strongly benefiting from MT. Prospective studies are warranted.
Databáze: OpenAIRE
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