Perfusion Imaging and Clinical Outcome in Acute Ischemic Stroke with Large Core. Issue 3 (29th July 2021)

• Record Type: Journal Article
• Authors: Seners, Pierre; Oppenheim, Catherine; Turc, Guillaume; Albucher, Jean‐François; Guenego, Adrien; Raposo, Nicolas; Christensen, Soren; Calvière, Lionel; Viguier, Alain; Darcourt, Jean; Januel, Anne‐Christine; Mlynash, Michael; Sommet, Agnes; Thalamas, Claire; Sibon, Igor; Rousseau, Vanessa; Tourdias, Thomas; Menegon, Patrice; Bonneville, Fabrice; Mazighi, Mikael; Charron, Sylvain; Legrand, Laurence; Cognard, Christophe; Albers, Gregory W.; Baron, Jean‐Claude; Olivot, Jean‐Marc
• Other Names: Chollet François investigator.; Fontaine Louis investigator.; Barbieux Marianne investigator.; Michelozzi Caterina investigator.; Tall Philippe investigator.; Caparros François investigator.; Pouzet Brigitte investigator.; Calvas Fabienne investigator.; Galitzki Monique investigator.; Drif Amel investigator.; Renou Pauline investigator.; Rouanet François investigator.; Berge Jerome investigator.; Marnat Gauthier investigator.; Menegon Patrice investigator.; Lucas Ludovic investigator.; Coignon Cyrielle investigator.; Sagnier Sharmila investigator.; Debruxelle Sabrina investigator.; Ledure Sylvain investigator.
• Is Part Of: Annals of neurology. Volume 90:Issue 3(2021)
• Page Start: 417
• Page End: 427
• Publication Date: 2021-07-29
• Subjects: Neurology -- Periodicals; Pediatric neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; 616.8
• DOI: 10.1002/ana.26152
• Languages: English
• ISSNs: 0364-5134

Abstract

Abstract : Objective: 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. Methods: 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). Results: 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 interaction < 0.001 for continuous MMRatio); MT was associated with a higher rate of good outcome in patients with, but not in those without, MMRatio>1.2 (adjusted OR [95% CI] = 6.8 [1.7–27.0] vs 0.7 [0.1–6.2], respectively). Similar findings were present for MMRatio ≥1.8 in the subgroup with core ≥70 ml. Parenchymal hemorrhage on follow‐up imaging was more frequent in the MT + BMM group regardless of the MMRatio. Interpretation: 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