Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue
Maarten G Lansberg, Carlo W Cereda, Michael Mlynash, Nishant K Mishra, Manabu Inoue, Stephanie Kemp, Søren Christensen, Matus Straka, Greg Zaharchuk, Michael P Marks, Roland Bammer, Gregory W Albers, Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) Study Investigators, J Saver, P Fayad, G Howard, T Tomsick, T Jovin, L Wechsler, S DeCesare, D Thai, A Sherr, M Wilder, A Tricot, H Lutsep, L McDaneld, D Larsen, T Czartoski, B Keogh, A M Malik, A Brown, R Bernstein, K Muskovich, C Chang, T Stern, S Warach, L Davis, F Fazekas, T Seifert-Held, Maarten G Lansberg, Carlo W Cereda, Michael Mlynash, Nishant K Mishra, Manabu Inoue, Stephanie Kemp, Søren Christensen, Matus Straka, Greg Zaharchuk, Michael P Marks, Roland Bammer, Gregory W Albers, Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) Study Investigators, J Saver, P Fayad, G Howard, T Tomsick, T Jovin, L Wechsler, S DeCesare, D Thai, A Sherr, M Wilder, A Tricot, H Lutsep, L McDaneld, D Larsen, T Czartoski, B Keogh, A M Malik, A Brown, R Bernstein, K Muskovich, C Chang, T Stern, S Warach, L Davis, F Fazekas, T Seifert-Held
Abstract
Objective: To evaluate whether time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on MRI.
Methods: Patients from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) cohort study with a perfusion-diffusion target mismatch were included. Reperfusion was defined as a decrease in the perfusion lesion volume of at least 50% between baseline and early follow-up. Good functional outcome was defined as a modified Rankin Scale score ≤2 at day 90. Lesion growth was defined as the difference between the baseline and the early follow-up diffusion-weighted imaging lesion volumes.
Results: Among 78 patients with the target mismatch profile (mean age 66 ± 16 years, 54% women), reperfusion was associated with increased odds of good functional outcome (adjusted odds ratio 3.7, 95% confidence interval 1.2-12, p = 0.03) and attenuation of lesion growth (p = 0.02). Time to treatment did not modify these effects (p value for the time × reperfusion interaction is 0.6 for good functional outcome and 0.3 for lesion growth). Similarly, in the subgroup of patients with reperfusion (n = 46), time to treatment was not associated with good functional outcome (p = 0.2).
Conclusion: The association between endovascular reperfusion and improved functional and radiologic outcomes is not time-dependent in patients with a perfusion-diffusion mismatch. Proof that patients with mismatch benefit from endovascular therapy in the late time window should come from a randomized placebo-controlled trial.
© 2015 American Academy of Neurology.
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Source: PubMed