Outcome of patients with proximal vessel occlusion of the anterior circulation and DWI-PWI mismatch is time-dependent

• Verfasst von: Mundiyanapurath, Sibu [VerfasserIn]
• Verfasst von: Diatschuk, Sascha [VerfasserIn]
• Verfasst von: Loebel, Sarah [VerfasserIn]
• Verfasst von: Pfaff, Johannes [VerfasserIn]
• Verfasst von: Pham, Mirko [VerfasserIn]
• Verfasst von: Möhlenbruch, Markus Alfred [VerfasserIn]
• Verfasst von: Wick, Wolfgang [VerfasserIn]
• Verfasst von: Bendszus, Martin [VerfasserIn]
• Verfasst von: Ringleb, Peter A. [VerfasserIn]
• Verfasst von: Radbruch, Alexander [VerfasserIn]
• Titel: Outcome of patients with proximal vessel occlusion of the anterior circulation and DWI-PWI mismatch is time-dependent
• Verf.angabe: Sibu Mundiyanapurath, Sascha Diatschuk, Sarah Loebel, Johannes Pfaff, Mirko Pham, Markus Alfred Möhlenbruch, Wolfgang Wick, Martin Bendszus, Peter A. Ringleb, Alexander Radbruch
• E-Jahr: 2017
• Jahr: June 2017
• Umfang: 6 S.
• Fussnoten: Gesehen am 28.08.2018
• Titel Quelle: Enthalten in: European journal of radiology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1990
• Jahr Quelle: 2017
• Band/Heft Quelle: 91(2017), Seite 82-87
• ISSN Quelle: 1872-7727
• DOI: doi:10.1016/j.ejrad.2017.03.016
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Endovascular therapy
• Sach-SW: Ischemic stroke
• Sach-SW: Magnetic resonance perfusion
• Sach-SW: Mismatch
• Sach-SW: Penumbra
• Sach-SW: Symptom onset-to-treatment time
• K10plus-PPN: 1580442609

Abstract

Background and purpose Patients with ischemic stroke and large vessel occlusion are assumed to benefit from endovascular therapy (ET) independent of the symptom onset-to-treatment time (OTT) if they present with a mismatch of diffusion- and perfusion-weighted imaging (DWI-PWI mismatch). We aimed at studying the influence of OTT on clinical outcome in these patients. Methods Retrospective database review in a tertiary care university hospital. All patients presented with proximal vessel occlusion of the anterior circulation and DWI-PWI mismatch. Primary outcome was the influence of OTT on modified Rankin scale (mRS) score three months after treatment, dichotomized in favourable (0-2) and unfavourable outcome (3-6). Secondary outcome was the effect of OTT on the shift of the mRS score. Patients treated within an early time window (<340min) and a late time window (≥340min) were compared. Results 139 patients were included. The rate of favourable outcome was significantly higher in patients who were treated in an early compared to those treated in a late time window (31 [49%] vs. 20 patients [27%], p=0.005). Adjusted multivariate logistic regression revealed that late treatment was an independent negative predictor of favourable outcome (odds ratio 0.39, confidence interval [0.18-0.84]; p=0.016). A shift towards higher mRS scores for late treatment was evident (p=0.015). In sensitivity analysis, OTT remained an independent predictor when evaluated as continuous variable. These findings were confirmed in patients with a comparable DWI-PWI mismatch according to the definitions from large trials (DEFUSE 2, DEFUSE 3, SWIFT-PRIME, EXTEND-IA). Conclusion Outcome of patients with comparable DWI-PWI mismatch is time-dependent.