Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue

被引：81

作者：

Lansberg, Maarten G. ^{[1
]}

Cereda, Carlo W. ^{[1
,2
]}

Mlynash, Michael ^{[1
]}

Mishra, Nishant K. ^{[1
]}

Inoue, Manabu ^{[1
]}

Kemp, Stephanie ^{[1
]}

Christensen, Soren ^{[1
]}

Straka, Matus ^{[1
]}

Zaharchuk, Greg ^{[1
]}

Marks, Michael P. ^{[1
]}

Bammer, Roland ^{[1
]}

Albers, Gregory W. ^{[1
]}

机构：

[1] Stanford Univ, Dept Neurol, Stanford Stroke Ctr, Palo Alto, CA 94304 USA

[2] Neuroctr EOC Southern Switzerland, Dept Neurol, Stroke Ctr, Lugano, Switzerland

来源：

NEUROLOGY | 2015年 / 85卷 / 08期

关键词：

ACUTE ISCHEMIC-STROKE; IMAGING SELECTION; TRIAL; WINDOW; THERAPY;

D O I：

10.1212/WNL.0000000000001853

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objective:To evaluate whether time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on MRI.Methods:Patients from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) cohort study with a perfusion-diffusion target mismatch were included. Reperfusion was defined as a decrease in the perfusion lesion volume of at least 50% between baseline and early follow-up. Good functional outcome was defined as a modified Rankin Scale score 2 at day 90. Lesion growth was defined as the difference between the baseline and the early follow-up diffusion-weighted imaging lesion volumes.Results:Among 78 patients with the target mismatch profile (mean age 66 16 years, 54% women), reperfusion was associated with increased odds of good functional outcome (adjusted odds ratio 3.7, 95% confidence interval 1.2-12, p = 0.03) and attenuation of lesion growth (p = 0.02). Time to treatment did not modify these effects (p value for the time x reperfusion interaction is 0.6 for good functional outcome and 0.3 for lesion growth). Similarly, in the subgroup of patients with reperfusion (n = 46), time to treatment was not associated with good functional outcome (p = 0.2).Conclusion:The association between endovascular reperfusion and improved functional and radiologic outcomes is not time-dependent in patients with a perfusion-diffusion mismatch. Proof that patients with mismatch benefit from endovascular therapy in the late time window should come from a randomized placebo-controlled trial.

引用

页码：708 / 714

页数：7

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