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Outcome of patients with proximal vessel occlusion of the anterior circulation and DWI-PWI mismatch is time-dependent

Background and purpose Patients with ischemic stroke and large vessel occlusion are assumed to benefit from endovascular therapy (ET) independent of the symptom onset-to-treatment time (OTT) if they present with a mismatch of diffusion- and perfusion-weighted imaging (DWI-PWI mismatch). We aimed at...

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Main Authors: Mundiyanapurath, Sibu (Author) , Diatschuk, Sascha (Author) , Loebel, Sarah (Author) , Pfaff, Johannes (Author) , Pham, Mirko (Author) , Möhlenbruch, Markus Alfred (Author) , Wick, Wolfgang (Author) , Bendszus, Martin (Author) , Ringleb, Peter A. (Author) , Radbruch, Alexander (Author)
Format: Article (Journal)
Language:English
Published: June 2017
In: European journal of radiology
Year: 2017, Volume: 91, Pages: 82-87
ISSN:1872-7727
DOI:10.1016/j.ejrad.2017.03.016
Online Access:Verlag, Volltext: http://dx.doi.org/10.1016/j.ejrad.2017.03.016
Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S0720048X1730116X
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Author Notes:Sibu Mundiyanapurath, Sascha Diatschuk, Sarah Loebel, Johannes Pfaff, Mirko Pham, Markus Alfred Möhlenbruch, Wolfgang Wick, Martin Bendszus, Peter A. Ringleb, Alexander Radbruch
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Summary:Background and purpose Patients with ischemic stroke and large vessel occlusion are assumed to benefit from endovascular therapy (ET) independent of the symptom onset-to-treatment time (OTT) if they present with a mismatch of diffusion- and perfusion-weighted imaging (DWI-PWI mismatch). We aimed at studying the influence of OTT on clinical outcome in these patients. Methods Retrospective database review in a tertiary care university hospital. All patients presented with proximal vessel occlusion of the anterior circulation and DWI-PWI mismatch. Primary outcome was the influence of OTT on modified Rankin scale (mRS) score three months after treatment, dichotomized in favourable (0-2) and unfavourable outcome (3-6). Secondary outcome was the effect of OTT on the shift of the mRS score. Patients treated within an early time window (<340min) and a late time window (≥340min) were compared. Results 139 patients were included. The rate of favourable outcome was significantly higher in patients who were treated in an early compared to those treated in a late time window (31 [49%] vs. 20 patients [27%], p=0.005). Adjusted multivariate logistic regression revealed that late treatment was an independent negative predictor of favourable outcome (odds ratio 0.39, confidence interval [0.18-0.84]; p=0.016). A shift towards higher mRS scores for late treatment was evident (p=0.015). In sensitivity analysis, OTT remained an independent predictor when evaluated as continuous variable. These findings were confirmed in patients with a comparable DWI-PWI mismatch according to the definitions from large trials (DEFUSE 2, DEFUSE 3, SWIFT-PRIME, EXTEND-IA). Conclusion Outcome of patients with comparable DWI-PWI mismatch is time-dependent.
Item Description:Gesehen am 28.08.2018
Physical Description:Online Resource
ISSN:1872-7727
DOI:10.1016/j.ejrad.2017.03.016

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