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SHR Neuro Cancer Cardio Lipid Metab Microb

Lansberg, MG; Cereda, CW; Mlynash, M; Mishra, NK; Inoue, M; Kemp, S; Christensen, S; Straka, M; Zaharchuk, G; Marks, MP; Bammer, R; Albers, GW; Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) Study Investigators.
Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue.
Neurology. 2015; 85(8): 708-714. Doi: 10.1212/WNL.0000000000001853 [OPEN ACCESS]
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Study Group Members Med Uni Graz:: Seifert-Held Thomas
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Abstract:: To evaluate whether time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on MRI. 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. 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 × 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). 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. © 2015 American Academy of Neurology.
Find related publications in this database (using NLM MeSH Indexing): Aged -; Aged, 80 and over -; Cerebrovascular Circulation - physiology; Endovascular Procedures - standards; Female -; Follow-Up Studies -; Humans -; Magnetic Resonance Imaging -; Male -; Middle Aged -; Outcome Assessment (Health Care) -; Reperfusion - standards; Stroke - pathology; Stroke - therapy; Time Factors -