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MRI-Based Selection for Intra-Arterial Stroke Therapy
- Source :
- Stroke. 40:2046-2054
- Publication Year :
- 2009
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2009.
-
Abstract
- Background and Purpose— Recent studies demonstrate that an acute diffusion-weighted imaging lesion volume >70 cm 3 predicts poor outcome in patients with stroke. We sought to determine if this threshold could identify patients treated with intra-arterial therapy who would do poorly despite reperfusion. In patients with initial infarcts 3 , we sought to determine what effect recanalization and time to recanalization had on infarct growth and functional outcome. Methods— We retrospectively studied 34 consecutive patients with anterior circulation stroke who underwent pretreatment diffusion-weighted imaging and perfusion-weighted imaging and subsequent intra-arterial therapy. Recanalization success and time to recanalization were recorded. Initial diffusion-weighted imaging and mean transit time lesion and final infarct volumes were determined. Patients were stratified based on initial infarct volume, recanalization status, and time to recanalization. Statistical tests were performed to assess differences in clinical and imaging outcomes. Good clinical outcome was defined as a 3-month modified Rankin Scale score ≤2. Results— Among patients with initial infarcts >70 cm 3 , all had poor outcomes despite a 50% recanalization rate with mean infarct growth of 114 cm 3 . These patients also had the largest mean transit time volumes ( P 3 who recanalized early had the best clinical outcomes ( P P 3 . Conclusion— This study supports the use of an acute diffusion-weighted imaging lesion volume threshold as an imaging selection criterion for intra-arterial therapy. It also confirms the importance of early reperfusion in selected patients.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Revascularization
Article
Lesion
Image Processing, Computer-Assisted
medicine
Humans
Thrombolytic Therapy
Stroke
Aged
Retrospective Studies
Aged, 80 and over
Advanced and Specialized Nursing
Cerebral Revascularization
medicine.diagnostic_test
Cerebral infarction
Vascular disease
business.industry
Retrospective cohort study
Magnetic resonance imaging
Cerebral Infarction
Middle Aged
medicine.disease
Diffusion Magnetic Resonance Imaging
Treatment Outcome
Acute Disease
Reperfusion
Female
Neurology (clinical)
Radiology
medicine.symptom
Tomography, X-Ray Computed
Cardiology and Cardiovascular Medicine
business
Diffusion MRI
Subjects
Details
- ISSN :
- 15244628 and 00392499
- Volume :
- 40
- Database :
- OpenAIRE
- Journal :
- Stroke
- Accession number :
- edsair.doi.dedup.....3f03efc526d0d3cff984f3fd0f5b9705