The impact of the DWI-FLAIR-mismatch in the ECASS-4 trial

• Verfasst von: Pfaff, Johannes [VerfasserIn]
• Verfasst von: Bendszus, Martin [VerfasserIn]
• Verfasst von: Donnan, Geoffrey [VerfasserIn]
• Verfasst von: Molina, Carlos [VerfasserIn]
• Verfasst von: Leys, Didier [VerfasserIn]
• Verfasst von: Schellinger, Peter D. [VerfasserIn]
• Verfasst von: Schwab, Stefan [VerfasserIn]
• Verfasst von: Toni, Danilo [VerfasserIn]
• Verfasst von: Wahlgren, Nils [VerfasserIn]
• Verfasst von: Hacke, Werner [VerfasserIn]
• Verfasst von: Ringleb, Peter A. [VerfasserIn]
• Titel: The impact of the DWI-FLAIR-mismatch in the ECASS-4 trial
• Titelzusatz: a post hoc analysis
• Verf.angabe: Johannes Ar Pfaff, Martin Bendszus, Geoffrey Donnan, Carlos Molina, Didier Leys, Peter D. Schellinger, Stefan Schwab, Danilo Toni, Nils Wahlgren, Werner Hacke and Peter Arthur Ringleb
• Jahr: 2020
• Umfang: 4 S.
• Teil: volume:5
• Teil: year:2020
• Teil: number:4
• Teil: pages:370-373
• Teil: extent:4
• Fussnoten: Gesehen am 13.07.2021
• Titel Quelle: Enthalten in: European stroke journal
• Ort Quelle: London : Sage Publishing, 2016
• Jahr Quelle: 2020
• Band/Heft Quelle: 5(2020), 4, Seite 370-373
• ISSN Quelle: 2396-9881
• DOI: doi:10.1177/2396987320920114
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: acute ischemic stroke
• Sach-SW: diffusion-weighted imaging
• Sach-SW: DWI-FLAIR-mismatch
• Sach-SW: European Cooperative Acute Stroke Study-4
• Sach-SW: fluid-attenuated inversion recovery
• Sach-SW: magnetic resonance imaging
• Sach-SW: Thrombolysis
• K10plus-PPN: 1762793288

Abstract

Introduction: To investigate the impact of a mismatch between diffusion-weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR) on functional outcome in patients with acute stroke in a prolonged time window or unknown time of symptom onset randomized to intravenous thrombolysis or placebo. Patients and Methods: We performed a post-hoc analysis of the European Cooperative Acute Stroke Study-4 (ECASS-4) trial. ECASS-4 was an investigator driven, phase 3, multi-center, double-blind, placebo-controlled study which randomized ischemic stroke patients presenting within 4.5 and 9h of stroke onset or unknown time-window to either rt-PA or placebo after MR-imaging. Two subgroups "no mismatch" (nMM) and "any mismatch" (aMM) were created by applying a DWI-FLAIR-mismatch criterion. We calculated frequency of nMM and aMM and performed a univariate analysis (Fisher's Test) for excellent clinical outcome (mRS 0-1) and mortality (mRS=6). Results: MR-Imaging of n=111/119 (93.2%) patients was suitable for this analysis. DWI-FLAIR mismatch was found in 49 patients (44.1%). Proportions of mismatch nMM and aMM were comparable in treatment-groups (aMM: Placebo 46.3%, Alteplase 42.1%; p=0.70). Patients with nMM showed no benefit of rt-PA-treatment (OR (95%CI) mRS 0-1: 0.95 (0.29-3.17)). Patients with aMM showed a point estimate of the odds ratio in favour of a treatment benefit of rt-PA (mRS 0-1: OR (95%CI) 2.62 (0.68-11.1)). Mortality within 90 days was not different in patients treated with rt-PA if nMM (15.2%) or aMM (12.5%) was present. Discussion: In this analysis no significant evidence, but subtle indication towards patients treated with rt-PA in a prolonged time window reaching an excellent clinical outcome if a DWI-FLAIR-mismatch is present on initial stroke MR-imaging. Conclusion: A DWI-FLAIR mismatch in the region of ischemia as imaging based surrogate parameter for patient selection for i.v. rt-PA should be strongly pursued.