Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke. Issue 6 (1st May 2015)

• Record Type: Journal Article
• Authors: Ozenne, Brice; Cho, Tae‐Hee; Mikkelsen, Irene Klærke; Hermier, Marc; Ribe, Lars; Thomalla, Götz; Pedraza, Salvador; Baron, Jean‐Claude; Roy, Pascal; Berthezène, Yves; Nighoghossian, Norbert; Østergaard, Leif; Maucort‐Boulch, Delphine
• Is Part Of: Journal of neuroimaging. Volume 25:Issue 6(2015)
• Page Start: 952
• Page End: 958
• Publication Date: 2015-05-01
• Subjects: Diagnostic imaging -- Periodicals; Nervous system -- Diseases -- Diagnosis -- Periodicals; Imagerie pour le diagnostic -- Périodiques; Système nerveux -- Maladies -- Diagnostic -- Périodiques; Imagerie médicale; Neuroimagerie; Neurologie; Système nerveux; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.804754
• DOI: 10.1111/jon.12255
• Languages: English
• ISSNs: 1051-2284

Abstract

<abstract abstract-type="main"> <title>ABSTRACT</title> <sec id="jon12255-sec-0010" sec-type="section"> <title>BACKGROUND AND PURPOSE</title> <p>Though still debated, early reperfusion is increasingly used as a biomarker for clinical outcome. However, the lack of a standard definition hinders the assessment of reperfusion therapies and study comparisons. The objective was to determine the optimal early reperfusion criteria that predicts clinical outcome in ischemic stroke.</p> </sec> <sec id="jon12255-sec-0020" sec-type="section"> <title>METHODS</title> <p>Early reperfusion was assessed voxel‐wise in 57 patients within 6 hours of symptom onset. The performance of the time to peak (TTP), the mean transit time (MTT), and the time to maximum of residue function (<italic>T</italic><sub>max</sub>) at various delays thresholds in predicting the neurological response (based on the National Institutes of Health Stroke Scale) and the functional outcome (modified Rankin scale ≤1) at 1 month were compared. A receiver operating characteristics (ROC) analysis determined the optimal extent of reperfusion. A novel unsupervised classification of reperfusion using group‐based trajectory modeling (GBTM) was evaluated.</p> </sec> <sec id="jon12255-sec-0030" sec-type="section"> <title>RESULTS</title> <p>MTT had a lower performance than TTP and <italic>T</italic><sub>max</sub> in predicting the neurological response (<italic>P</italic> = .008 vs. TTP and <italic>P</italic> = .006 vs. <italic>T</italic><sub>max</sub>) or the functional outcome (<italic>P</italic> = .0006 vs. TTP; <italic>P</italic> = .002 vs. <italic>T</italic><sub>max</sub>). No delay threshold had a significantly higher predictive value than another. The optimal percentage of reperfusion was dependent on the outcome scale (<italic>P</italic> < .001). The GBTM‐based classification of reperfusion was closely associated with the clinical outcome and had a similar accuracy compared to ROC‐based classification.</p> </sec> <sec id="jon12255-sec-0040" sec-type="section"> <title>CONCLUSIONS</title> <p>TTP and <italic>T</italic><sub>max</sub> should be preferred to MTT in defining early reperfusion. GBTM provided a clinically relevant reperfusion classification that does not require prespecified delay thresholds or clinical outcomes.</p> </sec> </abstract>