Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data.


Journal

The Lancet. Neurology
ISSN: 1474-4465
Titre abrégé: Lancet Neurol
Pays: England
ID NLM: 101139309

Informations de publication

Date de publication:
01 2019
Historique:
received: 08 04 2018
revised: 15 08 2018
accepted: 15 08 2018
pubmed: 11 11 2018
medline: 6 5 2020
entrez: 11 11 2018
Statut: ppublish

Résumé

CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome. In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1, 2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 μm We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) patients and diffusion MRI for 309 (18%) patients. Functional independence was worse in patients who had CTP versus those who had diffusion MRI, after adjustment for ischaemic core volume (odds ratio [OR] 0·47 [95% CI 0·30-0·72], p=0·0007), so the imaging modalities were not pooled. Increasing ischaemic core volume was associated with reduced likelihood of functional independence (CTP OR 0·77 [0·69-0·86] per 10 mL, p Estimated ischaemic core volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic core volume with age and expected imaging-to-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions. Medtronic.

Sections du résumé

BACKGROUND
CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome.
METHODS
In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1, 2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 μm
FINDINGS
We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) patients and diffusion MRI for 309 (18%) patients. Functional independence was worse in patients who had CTP versus those who had diffusion MRI, after adjustment for ischaemic core volume (odds ratio [OR] 0·47 [95% CI 0·30-0·72], p=0·0007), so the imaging modalities were not pooled. Increasing ischaemic core volume was associated with reduced likelihood of functional independence (CTP OR 0·77 [0·69-0·86] per 10 mL, p
INTERPRETATION
Estimated ischaemic core volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic core volume with age and expected imaging-to-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions.
FUNDING
Medtronic.

Identifiants

pubmed: 30413385
pii: S1474-4422(18)30314-4
doi: 10.1016/S1474-4422(18)30314-4
pii:
doi:

Substances chimiques

Fibrinolytic Agents 0
Tissue Plasminogen Activator EC 3.4.21.68

Types de publication

Comparative Study Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

46-55

Subventions

Organisme : Department of Health
ID : HTA/14/08/47
Pays : United Kingdom

Investigateurs

Olvert A Berkhemer (OA)
Puck Ss Fransen (PS)
Debbie Beumer (D)
Lucie A van den Berg (LA)
Hester F Lingsma (HF)
Albert J Yoo (AJ)
Wouter J Schonewille (WJ)
Jan Albert Vos (JA)
Paul J Nederkoorn (PJ)
Marieke Jh Wermer (MJ)
Marianne Aa van Walderveen (MA)
Julie Staals (J)
Jeannette Hofmeijer (J)
Jacques A van Oostayen (JA)
Geert J Lycklama À Nijeholt (GJ)
Jelis Boiten (J)
Patrick A Brouwer (PA)
Bart J Emmer (BJ)
Sebastiaan F de Bruijn (SF)
Lukas C van Dijk (LC)
Jaap Kappelle (J)
Rob H Lo (RH)
Ewoud J van Dijk (EJ)
Joost de Vries (J)
Paul L M de Kort (PLM)
Willem Jan J van Rooij (WJJ)
Jan S P van den Berg (JSP)
Boudewijn A A M van Hasselt (BAAM)
Leo A M Aerden (LAM)
René J Dallinga (RJ)
Marieke C Visser (MC)
Joseph C J Bot (JCJ)
Patrick C Vroomen (PC)
Omid Eshghi (O)
Tobien H C M L Schreuder (THCML)
Roel J J Heijboer (RJJ)
Koos Keizer (K)
Alexander V Tielbeek (AV)
Heleen M den Hertog (HM)
Dick G Gerrits (DG)
Renske M van den Berg-Vos (RM)
Giorgos B Karas (GB)
Ewout W Steyerberg (EW)
Zwenneke Flach (Z)
Henk A Marquering (HA)
Marieke E S Sprengers (MES)
Sjoerd F M Jenniskens (SFM)
Ludo F M Beenen (LFM)
René van den Berg (R)
Peter J Koudstaal (PJ)
Wim H van Zwam (WH)
Yvo B W E M Roos (YBWEM)
Aad van der Lugt (A)
Robert J van Oostenbrugge (RJ)
Charles B L M Majoie (CBLM)
Diederik W J Dippel (DWJ)
Martin M Brown (MM)
Thomas Liebig (T)
Theo Stijnen (T)
Tommy Andersson (T)
Heinrich Mattle (H)
Nils Wahlgren (N)
Esther van der Heijden (E)
Naziha Ghannouti (N)
Nadine Fleitour (N)
Imke Hooijenga (I)
Corina Puppels (C)
Wilma Pellikaan (W)
Annet Geerling (A)
Annemieke Lindl-Velema (A)
Gina van Vemde (G)
Ans de Ridder (A)
Paut Greebe (P)
José de Bont-Stikkelbroeck (J)
Joke de Meris (J)
Kirsten Janssen (K)
Willy Struijk (W)
Silvan Licher (S)
Nikki Boodt (N)
Adriaan Ros (A)
Esmee Venema (E)
Ilse Slokkers (I)
Raymie-Jayce Ganpat (RJ)
Maxim Mulder (M)
Nawid Saiedie (N)
Alis Heshmatollah (A)
Stefanie Schipperen (S)
Stefan Vinken (S)
Tiemen van Boxtel (T)
Jeroen Koets (J)
Merel Boers (M)
Emilie Santos (E)
Jordi Borst (J)
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Commentaires et corrections

Type : CommentIn
Type : ErratumIn

Informations de copyright

Copyright © 2019 Elsevier Ltd. All rights reserved.

Auteurs

Bruce C V Campbell (BCV)

Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia. Electronic address: bruce.campbell@mh.org.au.

Charles B L M Majoie (CBLM)

Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, Netherlands.

Gregory W Albers (GW)

Stanford Stroke Center, Stanford University, Stanford, CA, USA.

Bijoy K Menon (BK)

Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, AB, Canada.

Nawaf Yassi (N)

Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.

Gagan Sharma (G)

Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.

Wim H van Zwam (WH)

Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute (CARIM), Maastricht, Netherlands.

Robert J van Oostenbrugge (RJ)

Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute (CARIM), Maastricht, Netherlands.

Andrew M Demchuk (AM)

Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, AB, Canada.

Francis Guillemin (F)

Clinical Investigation Centre-Clinical Epidemiology, INSERM 1433, University of Lorraine and University Hospital of Nancy, Nancy, France.

Philip White (P)

Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.

Antoni Dávalos (A)

Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain.

Aad van der Lugt (A)

Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands.

Kenneth S Butcher (KS)

Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.

Aboubaker Cherifi (A)

Clinical Investigation Centre-Innovative Technology, INSERM 1433, University of Lorraine and University Hospital of Nancy, Nancy, France.

Henk A Marquering (HA)

Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, Netherlands; Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, Netherlands.

Geoffrey Cloud (G)

Stroke Unit, Alfred Hospital and Monash University, Melbourne, VIC, Australia.

Juan M Macho Fernández (JM)

Department of Radiology, Hospital Clínic, Barcelona, Spain.

Jeremy Madigan (J)

Department of Neuroradiology, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK.

Catherine Oppenheim (C)

Department of Neuroradiology, Sainte-Anne Hospital and Paris-Descartes University, INSERM U894, Paris, France.

Geoffrey A Donnan (GA)

The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.

Yvo B W E M Roos (YBWEM)

Department of Neurology, Academic Medical Center, Amsterdam, Netherlands.

Jai Shankar (J)

Department of Radiology, QEII Health Science Center, Dalhousie University, Halifax, NS, Canada.

Hester Lingsma (H)

Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands.

Alain Bonafé (A)

Department of Neuroradiology, Hôpital Gui-de Chauliac, Montpellier, France.

Hélène Raoult (H)

Department of Neuroradiology, CHU Pontchaillou, Rennes, France.

María Hernández-Pérez (M)

Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain.

Aditya Bharatha (A)

Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.

Reza Jahan (R)

Division of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, CA, USA.

Olav Jansen (O)

Department of Radiology and Neuroradiology, Universitätsklinikum Kiel, Kiel, Germany.

Sébastien Richard (S)

Department of Neurology, Stroke Unit, CIC-1433, INSERM U1116, University Hospital of Nancy, Nancy, France.

Elad I Levy (EI)

Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA.

Olvert A Berkhemer (OA)

Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, Netherlands; Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute (CARIM), Maastricht, Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands.

Marc Soudant (M)

Clinical Investigation Centre-Clinical Epidemiology, INSERM 1433, University of Lorraine and University Hospital of Nancy, Nancy, France.

Lucia Aja (L)

Department of Neurology, Hospital de Bellvitge, Barcelona, Spain.

Stephen M Davis (SM)

Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.

Timo Krings (T)

Department of Radiology, Toronto Western Hospital and University Health Network, University of Toronto, Toronto, ON, Canada.

Marie Tisserand (M)

Department of Neuroradiology, Foch Hospital, Suresnes, France.

Luis San Román (L)

Stroke Unit, Alfred Hospital and Monash University, Melbourne, VIC, Australia.

Alejandro Tomasello (A)

Radiology Department, Hospital Vall d'Hebron, Barcelona, Spain.

Debbie Beumer (D)

Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute (CARIM), Maastricht, Netherlands.

Scott Brown (S)

Altair Biostatistics, St Louis Park, MN, USA.

David S Liebeskind (DS)

Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA.

Serge Bracard (S)

Department of Diagnostic and Interventional Neuroradiology, INSERM U 947, University of Lorraine and University Hospital of Nancy, Nancy, France.

Keith W Muir (KW)

Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.

Diederik W J Dippel (DWJ)

Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands.

Mayank Goyal (M)

Department of Radiology, University of Calgary, Foothills Hospital, Calgary, AB, Canada.

Jeffrey L Saver (JL)

Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.

Tudor G Jovin (TG)

Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Michael D Hill (MD)

Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, AB, Canada.

Peter J Mitchell (PJ)

Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.

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