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Clinical relevance and practical implications of trials of perfusion and angiographic imaging in patients with acute ischaemic stroke: a multicentre cohort imaging study.

Wardlaw JM, Muir KW, Macleod MJ, Weir C, McVerry F, Carpenter T, Shuler K, Thomas R, Acheampong P, Dani K, Murray A - J. Neurol. Neurosurg. Psychiatr. (2013)

Bottom Line: Among 83 patients, median age 71 (maximum 89), median NIHSS 7 (range 1-30), 38 (46%) received alteplase, 41 (49%) had died or were dependent at 3 months.Most baseline imaging was CT (76%); follow-up was MR (79%) despite both being available acutely.Early recanalisation on angiography appeared to predict clinical outcome more directly than did tissue reperfusion.

View Article: PubMed Central - PubMed

Affiliation: Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK. Joanna.wardlaw@ed.ac.uk

ABSTRACT

Background: In randomised trials testing treatments for acute ischaemic stroke, imaging markers of tissue reperfusion and arterial recanalisation may provide early response indicators.

Objective: To determine the predictive value of structural, perfusion and angiographic imaging for early and late clinical outcomes and assess practicalities in three comprehensive stroke centres.

Methods: We recruited patients with potentially disabling stroke in three stroke centres, performed magnetic resonance (MR) or CT, including perfusion and angiography imaging, within 6 h, at 72 h and 1 month after stroke. We assessed the National Institutes of Health Stroke Scale (NIHSS) score serially and functional outcome at 3 months, tested associations between clinical variables and structural imaging, several perfusion parameters and angiography.

Results: Among 83 patients, median age 71 (maximum 89), median NIHSS 7 (range 1-30), 38 (46%) received alteplase, 41 (49%) had died or were dependent at 3 months. Most baseline imaging was CT (76%); follow-up was MR (79%) despite both being available acutely. At presentation, perfusion lesion size varied considerably between parameters (p<0.0001); 40 (48%) had arterial occlusion. Arterial occlusion and baseline perfusion lesion extent were both associated with baseline NIHSS (p<0.0001). Recanalisation by 72 h was associated with 1 month NIHSS (p=0.0007) and 3 month functional outcome (p=0.048), whereas tissue reperfusion, using even the best perfusion parameter, was not (p=0.11, p=0.08, respectively).

Conclusion: Early recanalisation on angiography appeared to predict clinical outcome more directly than did tissue reperfusion. Acute assessment with CT and follow-up with MR was practical and feasible, did not preclude image analysis, and would enhance trial recruitment and generalisability of results.

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Related in: MedlinePlus

Proportions of patients with/without a perfusion defect (on Tmax) and/or arterial obstruction within 6 h, at 72 h and 30 days after stroke. Numbers on bars are numbers of patients. Tmax, time to peak of the residue function, a measure of mean transit time.
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JNNP2012304807F3: Proportions of patients with/without a perfusion defect (on Tmax) and/or arterial obstruction within 6 h, at 72 h and 30 days after stroke. Numbers on bars are numbers of patients. Tmax, time to peak of the residue function, a measure of mean transit time.

Mentions: At baseline, 40/83 (48%) patients had an occluded intracranial artery, most being in the MCA main stem (22%) or MCA branch (27%, see online supplementary table S2). Sixteen patients without baseline arterial occlusion (16/43, 37%) had a baseline perfusion deficit on one or more perfusion parameters (figure 3, shows association for Tmax). Arterial occlusion persisted in 16 (40% of those with baseline occlusion or 22% of those imaged) at 72 h and in 4/48 (8%) at 30 days.


Clinical relevance and practical implications of trials of perfusion and angiographic imaging in patients with acute ischaemic stroke: a multicentre cohort imaging study.

Wardlaw JM, Muir KW, Macleod MJ, Weir C, McVerry F, Carpenter T, Shuler K, Thomas R, Acheampong P, Dani K, Murray A - J. Neurol. Neurosurg. Psychiatr. (2013)

Proportions of patients with/without a perfusion defect (on Tmax) and/or arterial obstruction within 6 h, at 72 h and 30 days after stroke. Numbers on bars are numbers of patients. Tmax, time to peak of the residue function, a measure of mean transit time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756443&req=5

JNNP2012304807F3: Proportions of patients with/without a perfusion defect (on Tmax) and/or arterial obstruction within 6 h, at 72 h and 30 days after stroke. Numbers on bars are numbers of patients. Tmax, time to peak of the residue function, a measure of mean transit time.
Mentions: At baseline, 40/83 (48%) patients had an occluded intracranial artery, most being in the MCA main stem (22%) or MCA branch (27%, see online supplementary table S2). Sixteen patients without baseline arterial occlusion (16/43, 37%) had a baseline perfusion deficit on one or more perfusion parameters (figure 3, shows association for Tmax). Arterial occlusion persisted in 16 (40% of those with baseline occlusion or 22% of those imaged) at 72 h and in 4/48 (8%) at 30 days.

Bottom Line: Among 83 patients, median age 71 (maximum 89), median NIHSS 7 (range 1-30), 38 (46%) received alteplase, 41 (49%) had died or were dependent at 3 months.Most baseline imaging was CT (76%); follow-up was MR (79%) despite both being available acutely.Early recanalisation on angiography appeared to predict clinical outcome more directly than did tissue reperfusion.

View Article: PubMed Central - PubMed

Affiliation: Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK. Joanna.wardlaw@ed.ac.uk

ABSTRACT

Background: In randomised trials testing treatments for acute ischaemic stroke, imaging markers of tissue reperfusion and arterial recanalisation may provide early response indicators.

Objective: To determine the predictive value of structural, perfusion and angiographic imaging for early and late clinical outcomes and assess practicalities in three comprehensive stroke centres.

Methods: We recruited patients with potentially disabling stroke in three stroke centres, performed magnetic resonance (MR) or CT, including perfusion and angiography imaging, within 6 h, at 72 h and 1 month after stroke. We assessed the National Institutes of Health Stroke Scale (NIHSS) score serially and functional outcome at 3 months, tested associations between clinical variables and structural imaging, several perfusion parameters and angiography.

Results: Among 83 patients, median age 71 (maximum 89), median NIHSS 7 (range 1-30), 38 (46%) received alteplase, 41 (49%) had died or were dependent at 3 months. Most baseline imaging was CT (76%); follow-up was MR (79%) despite both being available acutely. At presentation, perfusion lesion size varied considerably between parameters (p<0.0001); 40 (48%) had arterial occlusion. Arterial occlusion and baseline perfusion lesion extent were both associated with baseline NIHSS (p<0.0001). Recanalisation by 72 h was associated with 1 month NIHSS (p=0.0007) and 3 month functional outcome (p=0.048), whereas tissue reperfusion, using even the best perfusion parameter, was not (p=0.11, p=0.08, respectively).

Conclusion: Early recanalisation on angiography appeared to predict clinical outcome more directly than did tissue reperfusion. Acute assessment with CT and follow-up with MR was practical and feasible, did not preclude image analysis, and would enhance trial recruitment and generalisability of results.

Show MeSH
Related in: MedlinePlus