Time From Imaging to Endovascular Reperfusion Predicts Outcome in Acute Stroke

• Type of Material: Article
• Authors: Jenny P. Tsai, Stanford University; Michael Mlynash, Stanford University; Soren Christensen, Stanford University; Stephanie Kemp, Stanford University; Sun Kim, Stanford University; Nishant Mishra, Stanford University; Christian Federau, Stanford University; Raul Nogueira, Emory University; Tudor Jovin, University of Pittsburgh; Thomas G. Devlin, University of Tennessee; Naveed Akhtar, St Lukes Health System Kansas City; Dileep R. Yavagal, University of Miami; Roland Bammer, Stanford University; Matus Straka, Stanford University; Gregory Zaharchuk, Stanford University; Michael P. Marks, Stanford University; Gregory W. Albers, Stanford University; Maarten G. Lansberg, Stanford University
• Language: English
• Date: 2018-04-01
• Publisher: American Heart Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/STROKEAHA.117.018858
• Title of Journal or Parent Work: Stroke
• ISSN: 0039-2499
• Volume: 49
• Issue: 4
• Start Page: 952
• End Page: +
• Grant/Funding Information: The CT Perfusion to predict Response in Ischemic Stroke Project (CRISP) was funded by two grants from the NIH National Insitute of Neurological Disorders and Stroke (principal investigators, M.G.L. and G.W.A.).; The study was funded by 2 grants from the NIH National Institute of Neurological Disorders and Stroke (principal investigators, M.G.L. and G.W.A.).
• Keywords: Life Sciences & Biomedicine; stroke; Neurosciences & Neurology; ACUTE ISCHEMIC-STROKE; TRIAL; METAANALYSIS; Peripheral Vascular Disease; THROMBECTOMY; Cardiovascular System & Cardiology; reperfusion; thrombectomy; cerebral revascularization; Clinical Neurology; Science & Technology; perfusion imaging
• Research Categories: Health Sciences, General; Biology, Neuroscience

Abstract

Background and Purpose-This study aims to describe the relationship between computed tomographic (CT) perfusion (CTP)-to-reperfusion time and clinical and radiological outcomes, in a cohort of patients who achieve successful reperfusion for acute ischemic stroke. Methods-We included data from the CRISP (Computed Tomographic Perfusion to Predict Response in Ischemic Stroke Project) in which all patients underwent a baseline CTP scan before endovascular therapy. Patients were included if they had a mismatch on their baseline CTP scan and achieved successful endovascular reperfusion. Patients with mismatch were categorized into target mismatch and malignant mismatch profles, according to the volume of their Tmax >10s lesion volume (target mismatch, <100 mL; malignant mismatch, >100 mL). We investigated the impact of CTP-toreperfusion times on probability of achieving functional independence (modifed Rankin Scale, 0-2) at day 90 and radiographic outcomes at day 5. Results-Of 156 included patients, 108 (59%) had the target mismatch profle, and 48 (26%) had the malignant mismatch profle. In patients with the target mismatch profle, CTP-to-reperfusion time showed no association with functional independence (P=0.84), whereas in patients with malignant mismatch profle, CTP-to-reperfusion time was strongly associated with lower probability of functional independence (odds ratio, 0.08; P=0.003). Compared with patients with target mismatch, those with the malignant mismatch profle had signifcantly more infarct growth (90 [49-166] versus 43 [18-81] mL; P=0.006) and larger fnal infarct volumes (110 [61-155] versus 48 [21-99] mL; P=0.001). Conclusions-Compared with target mismatch patients, those with the malignant profle experience faster infarct growth and a steeper decline in the odds of functional independence, with longer delays between baseline imaging and reperfusion. However, this does not exclude the possibility of treatment beneft in patients with a malignant profle.