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Neurology. 2015 Aug 25;85(8):708-14. doi: 10.1212/WNL.0000000000001853. Epub 2015 Jul 29.

Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue.

Author information

1
From the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland. lansberg@stanford.edu.
2
From the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.

Abstract

OBJECTIVE:

To evaluate whether time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on MRI.

METHODS:

Patients from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) cohort study with a perfusion-diffusion target mismatch were included. Reperfusion was defined as a decrease in the perfusion lesion volume of at least 50% between baseline and early follow-up. Good functional outcome was defined as a modified Rankin Scale score ≤2 at day 90. Lesion growth was defined as the difference between the baseline and the early follow-up diffusion-weighted imaging lesion volumes.

RESULTS:

Among 78 patients with the target mismatch profile (mean age 66 ± 16 years, 54% women), reperfusion was associated with increased odds of good functional outcome (adjusted odds ratio 3.7, 95% confidence interval 1.2-12, p = 0.03) and attenuation of lesion growth (p = 0.02). Time to treatment did not modify these effects (p value for the time × reperfusion interaction is 0.6 for good functional outcome and 0.3 for lesion growth). Similarly, in the subgroup of patients with reperfusion (n = 46), time to treatment was not associated with good functional outcome (p = 0.2).

CONCLUSION:

The association between endovascular reperfusion and improved functional and radiologic outcomes is not time-dependent in patients with a perfusion-diffusion mismatch. Proof that patients with mismatch benefit from endovascular therapy in the late time window should come from a randomized placebo-controlled trial.

PMID:
26224727
PMCID:
PMC4553034
DOI:
10.1212/WNL.0000000000001853
[Indexed for MEDLINE]
Free PMC Article

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