Value of Computed Tomographic Perfusion-Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment
| Autor: | Borst, J., Berkhemer, O.A., Roos, Y.B., Bavel, E. Van, Zwam, W.H. van, Oostenbrugge, R.J. van, Walderveen, M.A. van, Lingsma, H.F., Lugt, A. van der, Dippel, D.W., Yoo, A.J., Marquering, H.A., Majoie, C.B., Dijk, E.J. van, Vries, J. de, Jenniskens, S.F.M. |
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| Přispěvatelé: | Neurosciences, Radiology & Nuclear Medicine, Public Health, Neurology, RS: CARIM - R3 - Vascular biology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: DA BV Medisch Specialisten Radiologie (9), Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), Biomedical Engineering and Physics, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, Graduate School, Other Research, Other departments |
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
perfusion imaging Perfusion scanning THERAPY Brain Ischemia law.invention Cohort Studies Brain ischemia Randomized controlled trial Modified Rankin Scale law Medicine Stroke Aged 80 and over Penumbra Middle Aged THROMBECTOMY Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] stroke DIFFUSION Treatment Outcome Cardiology interventional neuroradiology Female IMAGING SELECTION INFARCT CORE Cardiology and Cardiovascular Medicine Adult PENUMBRA medicine.medical_specialty Young Adult Internal medicine ischemic stroke Humans Infusions Intra-Arterial Aged Advanced and Specialized Nursing BLOOD-FLOW business.industry Patient Selection Other Research Radboud Institute for Health Sciences [Radboudumc 0] computed tomography Odds ratio medicine.disease Confidence interval Surgery ENDOVASCULAR TREATMENT VOLUME Neurology (clinical) Tomography X-Ray Computed business CT PERFUSION |
| Zdroj: | Stroke, 46(12), 3375-3382. Lippincott Williams & Wilkins Stroke, 46(12), 3375-3382. LIPPINCOTT WILLIAMS & WILKINS Stroke, 46, 12, pp. 3375-82 Stroke, 46, 3375-82 Stroke Stroke, 46(12), 3375-3382 Stroke; a journal of cerebral circulation, 46(12), 3375-3382. Lippincott Williams and Wilkins |
| ISSN: | 0039-2499 |
| Popis: | Background and Purpose— The utility of computed tomographic perfusion (CTP)–based patient selection for intra-arterial treatment of acute ischemic stroke has not been proven in randomized trials and requires further study in a cohort that was not selected based on CTP. Our objective was to study the relationship between CTP-derived parameters and outcome and treatment effect in patients with acute ischemic stroke because of a proximal intracranial arterial occlusion. Methods— We included 175 patients who underwent CTP in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN). Association of CTP-derived parameters (ischemic-core volume, penumbra volume, and percentage ischemic core) with outcome was estimated with multivariable ordinal logistic regression as an adjusted odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale. Interaction between CTP-derived parameters and treatment effect was determined using multivariable ordinal logistic regression. Interaction with treatment effect was also tested for mismatch (core 1.2; penumbra core >10 mL). Results— The adjusted odds ratio for improved functional outcome for ischemic core, percentage ischemic core, and penumbra were 0.79 per 10 mL (95% confidence interval: 0.71–0.89; P P =0.002), and 0.97 per 10 mL (96% confidence interval: 0.92–1.01; P =0.15), respectively. No significant interaction between any of the CTP-derived parameters and treatment effect was observed. We observed no significant interaction between mismatch and treatment effect. Conclusions— CTP seems useful for predicting functional outcome, but cannot reliably identify patients who will not benefit from intra-arterial therapy. |
| Databáze: | OpenAIRE |
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