http://stroke.ahajournals.org/content/47/1/99.abstract?sid=9902c2fc-fc05-40fb-b6dc-2e313e0096c5
- Hongyu An, DSc*;
- Andria L. Ford, MD*;
- Cihat Eldeniz, PhD;
- Yasheng Chen, DSc;
- Katie D. Vo, MD;
- Hongtu Zhu, PhD;
- William J. Powers, MD;
- Weili Lin, PhD;
- Jin-Moo Lee, MD, PhD
+ Author Affiliations
- Correspondence to Jin-Moo Lee, MD, Washington University, School of Medicine, Department of Neurology, 600 South Euclid Ave, Campus Box 8111, Saint Louis, Missouri 63110, E-mail leejm@neuro.wustl.edu or Weili Lin, PhD, University of North Carolina, 106 Mason Farm Rd, Campus Box 7515, Chapel Hill, NC 27599, E-mail weili_lin@med.unc.edu
-
↵* Drs An and Ford contributed equally.
Abstract
Background and Purpose—We aimed to examine perfusion changes between 3 and 6 and 6 and 24 hours after stroke onset and their impact on tissue outcome.
Methods—Acute
ischemic stroke patients underwent perfusion magnetic resonance imaging
at 3, 6, and 24 hours after stroke onset and
follow-up fluid-attenuated inversion recovery
at 1 month to assess tissue fate. Mean transit time prolongation maps
(MTTp=MTT–[median
MTT of contralateral hemisphere]) were
obtained at 3 (MTTp3 h), 6 (MTTp6 h), and 24 hours (MTTp24 h). Perfusion changes between 3 and 6 hours (ΔMTTp3_6) and 6 and 24 hours (ΔMTTp6_24) were calculated. A 2-step analysis was performed to evaluate the impact of ΔMTTp3_6 and ΔMTTp6_24 on tissue fate. First, a voxel-based multivariable logistic regression was performed for each individual patient with MTTp3 h, ΔMTTp3_6, and ΔMTT6_24 as independent variables and tissue fate as outcome. Second, Wilcoxon signed-rank tests on logistic regression coefficients
were performed across patients to evaluate whether ΔMTTp3_6 and ΔMTT6_24 had significant impact on tissue fate for varying severities of baseline perfusion.
Results—Perfusion change was common during both time periods: 85% and 81% of patients had perfusion improvement during 3- to 6- and
6- and 24-hour time intervals, respectively. ΔMTT3_6 significantly influenced 1-month infarct probability across a wide range of baseline perfusion (MTTp 0–15 s). ΔMTT6_24 also impacted 1-month infarct probability, but its influence was restricted to tissue with milder baseline ischemia (MTTp
0–10 s).
Conclusions—Brain tissue with mild to moderate ischemia can be salvaged by reperfusion even after 6 hours. Such tissue could be targeted
for intervention beyond current treatment windows.
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