Perfusion Imaging and Clinical Outcome in Acute Minor Stroke With Large Vessel Occlusion. Issue 11 (12th July 2022)

• Record Type: Journal Article
• Authors: Seners, Pierre; Arquizan, Caroline; Fontaine, Louis; Ben Hassen, Wagih; Heldner, Mirjam R.; Strambo, Davide; Nagel, Simon; Carrera, Emmanuel; Mechtouff, Laura; McCullough-Hicks, Margy; Mohammaden, Mahmoud H.; Cottier, Jean-Philippe; Henon, Hilde; Aignatoaie, Andreea; Laksiri, Nadia; Papassin, Jérémie; Lucas, Ludovic; Garnier, Pierre; Triquenot, Aude; Mione, Gioia; Hajdu, Steven; Costalat, Vincent; Potreck, Arne; Detante, Olivier; Bonneville, Fabrice; Berthezene, Yves; Bracard, Serge; Sibon, Igor; Bricout, Nicolas; Boutet, Claire; Mordasini, Pasquale; Michel, Patrik; Oppenheim, Catherine; Olivot, Jean-Marc; Nogueira, Raul G.; Albers, Gregory W.; Baron, Jean-Claude; Turc, Guillaume;
• Other Names: Cognard Christophe author non-byline.; Marnat Gaultier author non-byline.; Menegon Patrice author non-byline.; Ledure Sylvain author non-byline.; Dargazanli Cyril author non-byline.; Cho Tae-Hee author non-byline.; Nighoghossian Norbert author non-byline.; Eker Omer author non-byline.; Gouttard Sylvain author non-byline.; Haussen Diogo author non-byline.; Debiais Séverine author non-byline.; Charron Vladimir author non-byline.; Charron Nicolas author non-byline.; Leys Didier author non-byline.; Ozsancak Canan author non-byline.; Delpech Mathilde author non-byline.; Brunel Hervé author non-byline.; Papagiannaki Chrysanti author non-byline.; Girardin Emmanuel author non-byline.; Richard Sébastien author non-byline.; Gory Benjamin author non-byline.; Zbinden Martin author non-byline.; Dobrocky Tomas author non-byline.; Ringelb Peter author non-byline.; Möhlenbruch Markus author non-byline.
• Is Part Of: Stroke. Volume 53:Issue 11(2022)
• Page Start: 3429
• Page End: 3438
• Publication Date: 2022-07-12
• Subjects: incidence -- odds ratio -- perfusion imaging -- propensity score -- thrombectomy; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.122.039182
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background: Whether bridging therapy (intravenous thrombolysis [IVT] followed by mechanical thrombectomy) is superior to IVT alone in minor stroke with large vessel occlusion is unknown. Perfusion imaging may identify subsets of large vessel occlusion–related minor stroke patients with distinct response to bridging therapy. Methods: We conducted a multicenter international observational study of consecutive IVT-treated patients with minor stroke (National Institutes of Health Stroke Scale score ≤5) who had an anterior circulation large vessel occlusion and perfusion imaging performed before IVT, with a subset undergoing immediate thrombectomy. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month modified Rankin Scale score 0 to 1. We searched for an interaction between treatment group and mismatch volume (critical hypoperfusion–core volume). Results: Overall, 569 patients were included (172 and 397 in the bridging therapy and IVT groups, respectively). After propensity-score weighting, the distribution of baseline variables was similar across the 2 groups. In the entire population, bridging was associated with lower odds of achieving modified Rankin Scale score 0 to 1: odds ratio, 0.73 [95% CI, 0.55–0.96]; P =0.03. However, mismatch volume modified the effect of bridging on clinical outcome ( P interaction =0.04 for continuous mismatch volume); bridging was associated with worse outcome in patients with, but not in those without, mismatch volume <40 mL (odds ratio, [95% CI] for modified Rankin Scale score 0–1: 0.48 [0.33–0.71] versus 1.14 [0.76–1.71], respectively). Bridging was associated with higher incidence of symptomatic intracranial hemorrhage in the entire population, but this effect was present in the small mismatch subset only ( P interaction =0.002). Conclusions: In our population of large vessel occlusion-related minor stroke patients, bridging therapy was associated with lower rates of good outcome as compared with IVT alone. However, mismatch volume was a strong modifier of the effect of bridging therapy over IVT alone, notably with worse outcome with bridging therapy in patients with mismatch volume ≤40 mL. Randomized trials should consider adding perfusion imaging for patient selection.