Maximal Admission Core Lesion Compatible With Favorable Outcome in Acute Stroke Patients Undergoing Endovascular Procedures
| Autor: | Pilar Coscojuela, Jorge Pagola, Alan Flores, Marta Rubiera, David Rodriguez-Luna, Sandra Bonet, Carla Vert, Marian Muchada, Alejandro Tomasello, Marc Ribó, Carlos A. Molina, Alex Rovira, Miguel Lemus |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Middle Cerebral Artery medicine.medical_specialty Mechanical Thrombolysis Perfusion Imaging medicine.medical_treatment Blood volume Perfusion scanning Cohort Studies Lesion Modified Rankin Scale medicine.artery medicine Humans Stroke Aged Aged 80 and over Advanced and Specialized Nursing medicine.diagnostic_test business.industry Endovascular Procedures Age Factors Brain Infarction Middle Cerebral Artery Magnetic resonance imaging Thrombolysis Middle Aged Prognosis medicine.disease Diffusion Magnetic Resonance Imaging Logistic Models Treatment Outcome Cerebrovascular Circulation Middle cerebral artery Female Neurology (clinical) Radiology medicine.symptom Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Carotid Artery Internal |
| Zdroj: | Stroke. 46:2849-2852 |
| ISSN: | 1524-4628 0039-2499 |
| Popis: | Background and Purpose— Multiparametric imaging is meant to identify nonreversible lesions and predict on admission the minimum final infarct volume, a strong predictor of outcome. We aimed to confirm this hypothesis and define the maximal admission lesion volume compatible with favorable outcome (MALCOM). Methods— We studied patients with internal carotid artery/middle cerebral artery occlusion selected with multiparametric computed tomography/magnetic resonance imaging, who underwent endovascular procedures. Admission infarct core was measured on initial cerebral blood volume–computed tomography perfusion or diffusion weighted imaging–magnetic resonance imaging. We defined percentage of lesion growth (final lesion admission core/admission core) and MALCOM: cutoff admission core volume above which probability of modified Rankin Scale 0 to 2 is Results— Fifty-seven patients were studied (29 magnetic resonance imaging and 28 computed tomography perfusion). Mean core volume was 28±22 mL, and recanalization thrombolysis in cerebral ischemia 2b-3 was 77%. At 24 hours, mean infarct volume was 64±97 mL, and at 3 months modified Rankin Scale 0 to 2 was 45%. Median lesion growth was smaller in recanalizers (16.7% versus 198.3%; P 39 mL) achieved modified Rankin Scale 0 to 2 ( P =0.01). A regression model adjusted for age and recanalization showed that the only predictor of favorable outcome was having admission core lesion below MALCOM (OR: 9.3, 95% CI: 1.9–46.4; P Conclusions— Admission lesion core is associated with final infarct volume and is a strong predictor of favorable outcome. MALCOM according to imaging modality and patient age could be set and used on admission to select candidates for endovascular procedures. |
| Databáze: | OpenAIRE |
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