Time from imaging to endovascular reperfusion predicts outcome in acute stroke

Jenny P. Tsai, Michael Mlynash, Soren Christensen, Stephanie Kemp, Sun Kim, Nishant K. Mishra, Christian Federau, Raul G. Nogueira, Tudor G. Jovin, Thomas G. Devlin, Naveed Akhtar, Dileep R. Yavagal, Roland Bammer, Matus Straka, Gregory Zaharchuk, Michael P. Marks, Gregory W. Albers, Maarten G. Lansberg

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background and Purpose-This study aims to describe the relationship between computed tomographic (CT) perfusion (CTP)-to-reperfusion time and clinical and radiological outcomes, in a cohort of patients who achieve successful reperfusion for acute ischemic stroke. Methods-We included data from the CRISP (Computed Tomographic Perfusion to Predict Response in Ischemic Stroke Project) in which all patients underwent a baseline CTP scan before endovascular therapy. Patients were included if they had a mismatch on their baseline CTP scan and achieved successful endovascular reperfusion. Patients with mismatch were categorized into target mismatch and malignant mismatch profles, according to the volume of their Tmax >10s lesion volume (target mismatch, <100 mL; malignant mismatch, >100 mL). We investigated the impact of CTP-toreperfusion times on probability of achieving functional independence (modifed Rankin Scale, 0-2) at day 90 and radiographic outcomes at day 5. Results-Of 156 included patients, 108 (59%) had the target mismatch profle, and 48 (26%) had the malignant mismatch profle. In patients with the target mismatch profle, CTP-to-reperfusion time showed no association with functional independence (P=0.84), whereas in patients with malignant mismatch profle, CTP-to-reperfusion time was strongly associated with lower probability of functional independence (odds ratio, 0.08; P=0.003). Compared with patients with target mismatch, those with the malignant mismatch profle had signifcantly more infarct growth (90 [49-166] versus 43 [18-81] mL; P=0.006) and larger fnal infarct volumes (110 [61-155] versus 48 [21-99] mL; P=0.001). Conclusions-Compared with target mismatch patients, those with the malignant profle experience faster infarct growth and a steeper decline in the odds of functional independence, with longer delays between baseline imaging and reperfusion. However, this does not exclude the possibility of treatment beneft in patients with a malignant profle.

Original languageEnglish (US)
Pages (from-to)952-957
Number of pages6
JournalStroke
Volume49
Issue number4
DOIs
StatePublished - Apr 2018

Keywords

  • Cerebral revascularization
  • Perfusion imaging
  • Reperfusion
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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