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Reperfusion within 6 hours outperforms recanalization in predicting penumbra salvage, lesion growth, final infarct, and clinical outcome

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Reperfusion within 6 hours outperforms recanalization in predicting penumbra salvage, lesion growth, final infarct, and clinical outcome. / Cho, Tae-Hee; Nighoghossian, Norbert; Mikkelsen, Irene Klærke; Derex, Laurent; Hermier, Marc; Pedraza, Salvador; Fiehler, Jens; Østergaard, Leif; Berthezène, Yves; Baron, Jean-Claude.

in: STROKE, Jahrgang 46, Nr. 6, 06.2015, S. 1582-9.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Cho, T-H, Nighoghossian, N, Mikkelsen, IK, Derex, L, Hermier, M, Pedraza, S, Fiehler, J, Østergaard, L, Berthezène, Y & Baron, J-C 2015, 'Reperfusion within 6 hours outperforms recanalization in predicting penumbra salvage, lesion growth, final infarct, and clinical outcome', STROKE, Jg. 46, Nr. 6, S. 1582-9. https://doi.org/10.1161/STROKEAHA.114.007964

APA

Cho, T-H., Nighoghossian, N., Mikkelsen, I. K., Derex, L., Hermier, M., Pedraza, S., Fiehler, J., Østergaard, L., Berthezène, Y., & Baron, J-C. (2015). Reperfusion within 6 hours outperforms recanalization in predicting penumbra salvage, lesion growth, final infarct, and clinical outcome. STROKE, 46(6), 1582-9. https://doi.org/10.1161/STROKEAHA.114.007964

Vancouver

Cho T-H, Nighoghossian N, Mikkelsen IK, Derex L, Hermier M, Pedraza S et al. Reperfusion within 6 hours outperforms recanalization in predicting penumbra salvage, lesion growth, final infarct, and clinical outcome. STROKE. 2015 Jun;46(6):1582-9. https://doi.org/10.1161/STROKEAHA.114.007964

Bibtex

@article{220dceb9b4f84647a38fd376b4d33f69,
title = "Reperfusion within 6 hours outperforms recanalization in predicting penumbra salvage, lesion growth, final infarct, and clinical outcome",
abstract = "BACKGROUND AND PURPOSE: The relative merits of reperfusion versus recanalization to predict tissue and clinical outcomes in anterior circulation stroke have been previously assessed using data acquired >12 hours postonset. To avoid late-occurring confounders such as non-nutritional reperfusion, futile recanalization and no-reflow phenomenon, we performed ultraearly assessment of reperfusion and recanalization.METHODS: From a multicenter prospective database, 46 patients with acute magnetic resonance angiography-visible occlusion and in whom both reperfusion and recanalization were assessed on follow-up magnetic resonance imaging ≤6 hours of symptom onset were identified. Multiple linear regressions modeled salvaged penumbra, diffusion-weighted imaging lesion growth, and final infarct at 1 month using baseline clinical and imaging parameters and acute reperfusion or recanalization. Best predictors were determined with the Akaike information criterion. Univariate and multivariate logistic regressions identified the clinical and imaging predictors of clinical outcome.RESULTS: Admission magnetic resonance imaging showed M1 occlusion in 15 (33%) patients; median penumbra volume was 13.4 mL. Acute reperfusion was observed in 27 (59%) patients; 42% of nonrecanalized patients demonstrated reperfusion. The dichotomized classification of reperfusion and recanalization was discordant (P=0.0002). Reperfusion≤6 hours was a significant (P<0.05) predictor of increased penumbra salvage, reduced lesion growth, and final infarct size. Recanalization did not improve model accuracy. Reperfusion, but not recanalization, was significantly associated with good clinical outcome in logistic regressions.CONCLUSIONS: Reperfusion≤6 hours was consistently superior to recanalization in predicting tissue and clinical outcome. Reperfusion without recanalization was frequent and probably related to retrograde reperfusion through leptomeningeal collaterals. Acute reperfusion was the strongest predictor of, and may therefore, represent a reliable surrogate for, clinical outcome.",
keywords = "Aged, Brain Infarction, Cerebral Angiography, Databases, Factual, Female, Humans, Magnetic Resonance Angiography, Male, Middle Aged, Models, Biological, No-Reflow Phenomenon, Prospective Studies, Reperfusion, Time Factors, Treatment Outcome",
author = "Tae-Hee Cho and Norbert Nighoghossian and Mikkelsen, {Irene Kl{\ae}rke} and Laurent Derex and Marc Hermier and Salvador Pedraza and Jens Fiehler and Leif {\O}stergaard and Yves Berthez{\`e}ne and Jean-Claude Baron",
note = "{\textcopyright} 2015 American Heart Association, Inc.",
year = "2015",
month = jun,
doi = "10.1161/STROKEAHA.114.007964",
language = "English",
volume = "46",
pages = "1582--9",
journal = "STROKE",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

RIS

TY - JOUR

T1 - Reperfusion within 6 hours outperforms recanalization in predicting penumbra salvage, lesion growth, final infarct, and clinical outcome

AU - Cho, Tae-Hee

AU - Nighoghossian, Norbert

AU - Mikkelsen, Irene Klærke

AU - Derex, Laurent

AU - Hermier, Marc

AU - Pedraza, Salvador

AU - Fiehler, Jens

AU - Østergaard, Leif

AU - Berthezène, Yves

AU - Baron, Jean-Claude

N1 - © 2015 American Heart Association, Inc.

PY - 2015/6

Y1 - 2015/6

N2 - BACKGROUND AND PURPOSE: The relative merits of reperfusion versus recanalization to predict tissue and clinical outcomes in anterior circulation stroke have been previously assessed using data acquired >12 hours postonset. To avoid late-occurring confounders such as non-nutritional reperfusion, futile recanalization and no-reflow phenomenon, we performed ultraearly assessment of reperfusion and recanalization.METHODS: From a multicenter prospective database, 46 patients with acute magnetic resonance angiography-visible occlusion and in whom both reperfusion and recanalization were assessed on follow-up magnetic resonance imaging ≤6 hours of symptom onset were identified. Multiple linear regressions modeled salvaged penumbra, diffusion-weighted imaging lesion growth, and final infarct at 1 month using baseline clinical and imaging parameters and acute reperfusion or recanalization. Best predictors were determined with the Akaike information criterion. Univariate and multivariate logistic regressions identified the clinical and imaging predictors of clinical outcome.RESULTS: Admission magnetic resonance imaging showed M1 occlusion in 15 (33%) patients; median penumbra volume was 13.4 mL. Acute reperfusion was observed in 27 (59%) patients; 42% of nonrecanalized patients demonstrated reperfusion. The dichotomized classification of reperfusion and recanalization was discordant (P=0.0002). Reperfusion≤6 hours was a significant (P<0.05) predictor of increased penumbra salvage, reduced lesion growth, and final infarct size. Recanalization did not improve model accuracy. Reperfusion, but not recanalization, was significantly associated with good clinical outcome in logistic regressions.CONCLUSIONS: Reperfusion≤6 hours was consistently superior to recanalization in predicting tissue and clinical outcome. Reperfusion without recanalization was frequent and probably related to retrograde reperfusion through leptomeningeal collaterals. Acute reperfusion was the strongest predictor of, and may therefore, represent a reliable surrogate for, clinical outcome.

AB - BACKGROUND AND PURPOSE: The relative merits of reperfusion versus recanalization to predict tissue and clinical outcomes in anterior circulation stroke have been previously assessed using data acquired >12 hours postonset. To avoid late-occurring confounders such as non-nutritional reperfusion, futile recanalization and no-reflow phenomenon, we performed ultraearly assessment of reperfusion and recanalization.METHODS: From a multicenter prospective database, 46 patients with acute magnetic resonance angiography-visible occlusion and in whom both reperfusion and recanalization were assessed on follow-up magnetic resonance imaging ≤6 hours of symptom onset were identified. Multiple linear regressions modeled salvaged penumbra, diffusion-weighted imaging lesion growth, and final infarct at 1 month using baseline clinical and imaging parameters and acute reperfusion or recanalization. Best predictors were determined with the Akaike information criterion. Univariate and multivariate logistic regressions identified the clinical and imaging predictors of clinical outcome.RESULTS: Admission magnetic resonance imaging showed M1 occlusion in 15 (33%) patients; median penumbra volume was 13.4 mL. Acute reperfusion was observed in 27 (59%) patients; 42% of nonrecanalized patients demonstrated reperfusion. The dichotomized classification of reperfusion and recanalization was discordant (P=0.0002). Reperfusion≤6 hours was a significant (P<0.05) predictor of increased penumbra salvage, reduced lesion growth, and final infarct size. Recanalization did not improve model accuracy. Reperfusion, but not recanalization, was significantly associated with good clinical outcome in logistic regressions.CONCLUSIONS: Reperfusion≤6 hours was consistently superior to recanalization in predicting tissue and clinical outcome. Reperfusion without recanalization was frequent and probably related to retrograde reperfusion through leptomeningeal collaterals. Acute reperfusion was the strongest predictor of, and may therefore, represent a reliable surrogate for, clinical outcome.

KW - Aged

KW - Brain Infarction

KW - Cerebral Angiography

KW - Databases, Factual

KW - Female

KW - Humans

KW - Magnetic Resonance Angiography

KW - Male

KW - Middle Aged

KW - Models, Biological

KW - No-Reflow Phenomenon

KW - Prospective Studies

KW - Reperfusion

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1161/STROKEAHA.114.007964

DO - 10.1161/STROKEAHA.114.007964

M3 - SCORING: Journal article

C2 - 25908463

VL - 46

SP - 1582

EP - 1589

JO - STROKE

JF - STROKE

SN - 0039-2499

IS - 6

ER -