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Different Mismatch Concepts for Magnetic Resonance Imaging-Guided Thrombolysis in Unknown Onset Stroke

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Different Mismatch Concepts for Magnetic Resonance Imaging-Guided Thrombolysis in Unknown Onset Stroke. / Scheldeman, Lauranne; Wouters, Anke; Boutitie, Florent; Dupont, Patrick; Christensen, Soren; Cheng, Bastian; Ebinger, Martin; Endres, Matthias; Fiebach, Jochen B; Gerloff, Christian; Muir, Keith W; Nighoghossian, Norbert; Pedraza, Salvador; Simonsen, Claus Z; Thijs, Vincent; Thomalla, Götz; Lemmens, Robin; WAKE-UP Investigators.

In: ANN NEUROL, Vol. 87, No. 6, 06.2020, p. 931-938.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Scheldeman, L, Wouters, A, Boutitie, F, Dupont, P, Christensen, S, Cheng, B, Ebinger, M, Endres, M, Fiebach, JB, Gerloff, C, Muir, KW, Nighoghossian, N, Pedraza, S, Simonsen, CZ, Thijs, V, Thomalla, G, Lemmens, R & WAKE-UP Investigators 2020, 'Different Mismatch Concepts for Magnetic Resonance Imaging-Guided Thrombolysis in Unknown Onset Stroke', ANN NEUROL, vol. 87, no. 6, pp. 931-938. https://doi.org/10.1002/ana.25730

APA

Scheldeman, L., Wouters, A., Boutitie, F., Dupont, P., Christensen, S., Cheng, B., Ebinger, M., Endres, M., Fiebach, J. B., Gerloff, C., Muir, K. W., Nighoghossian, N., Pedraza, S., Simonsen, C. Z., Thijs, V., Thomalla, G., Lemmens, R., & WAKE-UP Investigators (2020). Different Mismatch Concepts for Magnetic Resonance Imaging-Guided Thrombolysis in Unknown Onset Stroke. ANN NEUROL, 87(6), 931-938. https://doi.org/10.1002/ana.25730

Vancouver

Scheldeman L, Wouters A, Boutitie F, Dupont P, Christensen S, Cheng B et al. Different Mismatch Concepts for Magnetic Resonance Imaging-Guided Thrombolysis in Unknown Onset Stroke. ANN NEUROL. 2020 Jun;87(6):931-938. https://doi.org/10.1002/ana.25730

Bibtex

@article{ad7c610cfd5f43ad866147523d6738ec,
title = "Different Mismatch Concepts for Magnetic Resonance Imaging-Guided Thrombolysis in Unknown Onset Stroke",
abstract = "OBJECTIVE: To explore the prevalence of the perfusion-weighted imaging (PWI)-diffusion-weighted imaging (DWI) mismatch and response to intravenous thrombolysis in the WAKE-UP trial.METHODS: We performed a prespecified post hoc analysis of ischemic stroke patients screened for DWI-fluid-attenuated inversion recovery (FLAIR) mismatch in WAKE-UP who underwent PWI. We defined PWI-DWI mismatch as ischemic core volume < 70ml, mismatch volume > 10ml, and mismatch ratio > 1.2. Primary efficacy end point was a modified Rankin Scale score of 0-1 at 90 days, adjusted for age and symptom severity.RESULTS: Of 1,362 magnetic resonance imaging-screened patients, 431 underwent PWI. Of these, 57 (13%) had a double mismatch, 151 (35%) only a DWI-FLAIR mismatch, and 54 (13%) only a PWI-DWI mismatch. DWI-FLAIR mismatch was more prevalent than PWI-DWI mismatch (48%, 95% confidence interval [CI] = 43-53% vs 26%, 95% CI = 22-30%; p < 0.0001). Screening for either one of the mismatch profiles resulted in a yield of 61% (95% CI = 56-65%). Prevalence of PWI-DWI mismatch was similar in patients with (27%) or without (24%) DWI-FLAIR mismatch (p = 0.52). In an exploratory analysis in the small subgroup of 208 randomized patients with PWI, PWI-DWI mismatch status did not modify the treatment response (p for interaction = 0.73).INTERPRETATION: Evaluating both the DWI-FLAIR and PWI-DWI mismatch patterns in patients with unknown time of stroke onset will result in the highest yield of thrombolysis treatment. The treatment benefit of alteplase in patients with a DWI-FLAIR mismatch seems to be driven not merely by the presence of a PWI-DWI mismatch, although this analysis was underpowered. ANN NEUROL 2020;87:931-938.",
author = "Lauranne Scheldeman and Anke Wouters and Florent Boutitie and Patrick Dupont and Soren Christensen and Bastian Cheng and Martin Ebinger and Matthias Endres and Fiebach, {Jochen B} and Christian Gerloff and Muir, {Keith W} and Norbert Nighoghossian and Salvador Pedraza and Simonsen, {Claus Z} and Vincent Thijs and G{\"o}tz Thomalla and Robin Lemmens and {WAKE-UP Investigators}",
note = "{\textcopyright} 2020 American Neurological Association.",
year = "2020",
month = jun,
doi = "10.1002/ana.25730",
language = "English",
volume = "87",
pages = "931--938",
journal = "ANN NEUROL",
issn = "0364-5134",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

RIS

TY - JOUR

T1 - Different Mismatch Concepts for Magnetic Resonance Imaging-Guided Thrombolysis in Unknown Onset Stroke

AU - Scheldeman, Lauranne

AU - Wouters, Anke

AU - Boutitie, Florent

AU - Dupont, Patrick

AU - Christensen, Soren

AU - Cheng, Bastian

AU - Ebinger, Martin

AU - Endres, Matthias

AU - Fiebach, Jochen B

AU - Gerloff, Christian

AU - Muir, Keith W

AU - Nighoghossian, Norbert

AU - Pedraza, Salvador

AU - Simonsen, Claus Z

AU - Thijs, Vincent

AU - Thomalla, Götz

AU - Lemmens, Robin

AU - WAKE-UP Investigators

N1 - © 2020 American Neurological Association.

PY - 2020/6

Y1 - 2020/6

N2 - OBJECTIVE: To explore the prevalence of the perfusion-weighted imaging (PWI)-diffusion-weighted imaging (DWI) mismatch and response to intravenous thrombolysis in the WAKE-UP trial.METHODS: We performed a prespecified post hoc analysis of ischemic stroke patients screened for DWI-fluid-attenuated inversion recovery (FLAIR) mismatch in WAKE-UP who underwent PWI. We defined PWI-DWI mismatch as ischemic core volume < 70ml, mismatch volume > 10ml, and mismatch ratio > 1.2. Primary efficacy end point was a modified Rankin Scale score of 0-1 at 90 days, adjusted for age and symptom severity.RESULTS: Of 1,362 magnetic resonance imaging-screened patients, 431 underwent PWI. Of these, 57 (13%) had a double mismatch, 151 (35%) only a DWI-FLAIR mismatch, and 54 (13%) only a PWI-DWI mismatch. DWI-FLAIR mismatch was more prevalent than PWI-DWI mismatch (48%, 95% confidence interval [CI] = 43-53% vs 26%, 95% CI = 22-30%; p < 0.0001). Screening for either one of the mismatch profiles resulted in a yield of 61% (95% CI = 56-65%). Prevalence of PWI-DWI mismatch was similar in patients with (27%) or without (24%) DWI-FLAIR mismatch (p = 0.52). In an exploratory analysis in the small subgroup of 208 randomized patients with PWI, PWI-DWI mismatch status did not modify the treatment response (p for interaction = 0.73).INTERPRETATION: Evaluating both the DWI-FLAIR and PWI-DWI mismatch patterns in patients with unknown time of stroke onset will result in the highest yield of thrombolysis treatment. The treatment benefit of alteplase in patients with a DWI-FLAIR mismatch seems to be driven not merely by the presence of a PWI-DWI mismatch, although this analysis was underpowered. ANN NEUROL 2020;87:931-938.

AB - OBJECTIVE: To explore the prevalence of the perfusion-weighted imaging (PWI)-diffusion-weighted imaging (DWI) mismatch and response to intravenous thrombolysis in the WAKE-UP trial.METHODS: We performed a prespecified post hoc analysis of ischemic stroke patients screened for DWI-fluid-attenuated inversion recovery (FLAIR) mismatch in WAKE-UP who underwent PWI. We defined PWI-DWI mismatch as ischemic core volume < 70ml, mismatch volume > 10ml, and mismatch ratio > 1.2. Primary efficacy end point was a modified Rankin Scale score of 0-1 at 90 days, adjusted for age and symptom severity.RESULTS: Of 1,362 magnetic resonance imaging-screened patients, 431 underwent PWI. Of these, 57 (13%) had a double mismatch, 151 (35%) only a DWI-FLAIR mismatch, and 54 (13%) only a PWI-DWI mismatch. DWI-FLAIR mismatch was more prevalent than PWI-DWI mismatch (48%, 95% confidence interval [CI] = 43-53% vs 26%, 95% CI = 22-30%; p < 0.0001). Screening for either one of the mismatch profiles resulted in a yield of 61% (95% CI = 56-65%). Prevalence of PWI-DWI mismatch was similar in patients with (27%) or without (24%) DWI-FLAIR mismatch (p = 0.52). In an exploratory analysis in the small subgroup of 208 randomized patients with PWI, PWI-DWI mismatch status did not modify the treatment response (p for interaction = 0.73).INTERPRETATION: Evaluating both the DWI-FLAIR and PWI-DWI mismatch patterns in patients with unknown time of stroke onset will result in the highest yield of thrombolysis treatment. The treatment benefit of alteplase in patients with a DWI-FLAIR mismatch seems to be driven not merely by the presence of a PWI-DWI mismatch, although this analysis was underpowered. ANN NEUROL 2020;87:931-938.

U2 - 10.1002/ana.25730

DO - 10.1002/ana.25730

M3 - SCORING: Journal article

C2 - 32227638

VL - 87

SP - 931

EP - 938

JO - ANN NEUROL

JF - ANN NEUROL

SN - 0364-5134

IS - 6

ER -