Perfusion Imaging and Clinical Outcome in Acute Ischemic Stroke with Large Core.
Aged
Aged, 80 and over
Brain Ischemia
/ diagnostic imaging
Cohort Studies
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
/ trends
Male
Middle Aged
Perfusion Imaging
/ trends
Prospective Studies
Retrospective Studies
Stroke
/ diagnostic imaging
Thrombectomy
/ methods
Tomography, X-Ray Computed
/ trends
Treatment Outcome
Journal
Annals of neurology
ISSN: 1531-8249
Titre abrégé: Ann Neurol
Pays: United States
ID NLM: 7707449
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
revised:
28
06
2021
received:
02
04
2021
accepted:
28
06
2021
pubmed:
4
7
2021
medline:
9
11
2021
entrez:
3
7
2021
Statut:
ppublish
Résumé
Mechanical thrombectomy (MT) is not recommended for acute stroke with large vessel occlusion (LVO) and a large volume of irreversibly injured tissue ("core"). Perfusion imaging may identify a subset of patients with large core who benefit from MT. We compared two cohorts of LVO-related patients with large core (>50 ml on diffusion-weighted-imaging or CT-perfusion using RAPID), available perfusion imaging, and treated within 6 hours from onset by either MT + Best Medical Management (BMM) in one prospective study, or BMM alone in the pre-MT era from a prospective registry. Primary outcome was 90-day modified Rankin Scale ≤2. We searched for an interaction between treatment group and amount of penumbra as estimated by the mismatch ratio (MMRatio = critical hypoperfusion/core volume). Overall, 107 patients were included (56 MT + BMM and 51 BMM): Mean age was 68 ± 15 years, median core volume 99 ml (IQR: 72-131) and MMRatio 1.4 (IQR: 1.0-1.9). Baseline clinical and radiological variables were similar between the two groups, except for a higher intravenous thrombolysis rate in the BMM group. The MMRatio strongly modified the clinical outcome following MT (p Perfusion imaging may help select which patients with large core should be considered for MT. Randomized studies are warranted. ANN NEUROL 2021;90:417-427.
Types de publication
Clinical Trial
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
417-427Investigateurs
François Chollet
(F)
Louis Fontaine
(L)
Marianne Barbieux
(M)
Caterina Michelozzi
(C)
Philippe Tall
(P)
François Caparros
(F)
Brigitte Pouzet
(B)
Fabienne Calvas
(F)
Monique Galitzki
(M)
Amel Drif
(A)
Pauline Renou
(P)
François Rouanet
(F)
Jerome Berge
(J)
Gauthier Marnat
(G)
Patrice Menegon
(P)
Ludovic Lucas
(L)
Cyrielle Coignon
(C)
Sharmila Sagnier
(S)
Sabrina Debruxelle
(S)
Sylvain Ledure
(S)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2021 American Neurological Association.
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