Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke
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Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke. / Ozenne, Brice; Cho, Tae-Hee; Mikkelsen, Irene Klaerke; Hermier, Marc; Ribe, Lars; Thomalla, Götz; Pedraza, Salvador; Baron, Jean-Claude; Roy, Pascal; Berthezène, Yves; Nighoghossian, Norbert; Østergaard, Leif; Maucort-Boulch, Delphine.
In: J NEUROIMAGING, Vol. 25, No. 6, 11.2015, p. 952-8.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke
AU - Ozenne, Brice
AU - Cho, Tae-Hee
AU - Mikkelsen, Irene Klaerke
AU - Hermier, Marc
AU - Ribe, Lars
AU - Thomalla, Götz
AU - Pedraza, Salvador
AU - Baron, Jean-Claude
AU - Roy, Pascal
AU - Berthezène, Yves
AU - Nighoghossian, Norbert
AU - Østergaard, Leif
AU - Maucort-Boulch, Delphine
N1 - Copyright © 2015 by the American Society of Neuroimaging.
PY - 2015/11
Y1 - 2015/11
N2 - BACKGROUND AND PURPOSE: Though still debated, early reperfusion is increasingly used as a biomarker for clinical outcome. However, the lack of a standard definition hinders the assessment of reperfusion therapies and study comparisons. The objective was to determine the optimal early reperfusion criteria that predicts clinical outcome in ischemic stroke.METHODS: Early reperfusion was assessed voxel-wise in 57 patients within 6 hours of symptom onset. The performance of the time to peak (TTP), the mean transit time (MTT), and the time to maximum of residue function (Tmax ) at various delays thresholds in predicting the neurological response (based on the National Institutes of Health Stroke Scale) and the functional outcome (modified Rankin scale ≤1) at 1 month were compared. A receiver operating characteristics (ROC) analysis determined the optimal extent of reperfusion. A novel unsupervised classification of reperfusion using group-based trajectory modeling (GBTM) was evaluated.RESULTS: MTT had a lower performance than TTP and Tmax in predicting the neurological response (P = .008 vs. TTP and P = .006 vs. Tmax ) or the functional outcome (P = .0006 vs. TTP; P = .002 vs. Tmax ). No delay threshold had a significantly higher predictive value than another. The optimal percentage of reperfusion was dependent on the outcome scale (P < .001). The GBTM-based classification of reperfusion was closely associated with the clinical outcome and had a similar accuracy compared to ROC-based classification.CONCLUSIONS: TTP and Tmax should be preferred to MTT in defining early reperfusion. GBTM provided a clinically relevant reperfusion classification that does not require prespecified delay thresholds or clinical outcomes.
AB - BACKGROUND AND PURPOSE: Though still debated, early reperfusion is increasingly used as a biomarker for clinical outcome. However, the lack of a standard definition hinders the assessment of reperfusion therapies and study comparisons. The objective was to determine the optimal early reperfusion criteria that predicts clinical outcome in ischemic stroke.METHODS: Early reperfusion was assessed voxel-wise in 57 patients within 6 hours of symptom onset. The performance of the time to peak (TTP), the mean transit time (MTT), and the time to maximum of residue function (Tmax ) at various delays thresholds in predicting the neurological response (based on the National Institutes of Health Stroke Scale) and the functional outcome (modified Rankin scale ≤1) at 1 month were compared. A receiver operating characteristics (ROC) analysis determined the optimal extent of reperfusion. A novel unsupervised classification of reperfusion using group-based trajectory modeling (GBTM) was evaluated.RESULTS: MTT had a lower performance than TTP and Tmax in predicting the neurological response (P = .008 vs. TTP and P = .006 vs. Tmax ) or the functional outcome (P = .0006 vs. TTP; P = .002 vs. Tmax ). No delay threshold had a significantly higher predictive value than another. The optimal percentage of reperfusion was dependent on the outcome scale (P < .001). The GBTM-based classification of reperfusion was closely associated with the clinical outcome and had a similar accuracy compared to ROC-based classification.CONCLUSIONS: TTP and Tmax should be preferred to MTT in defining early reperfusion. GBTM provided a clinically relevant reperfusion classification that does not require prespecified delay thresholds or clinical outcomes.
U2 - 10.1111/jon.12255
DO - 10.1111/jon.12255
M3 - SCORING: Journal article
C2 - 25940773
VL - 25
SP - 952
EP - 958
JO - J NEUROIMAGING
JF - J NEUROIMAGING
SN - 1051-2284
IS - 6
ER -