Perfusion imaging and clinical outcome in acute ischemic stroke with large core

More proof YOU NEED TO HAVE THE CORRECT STROKE. With nothing to be done by your doctor you will continue to lose 1.9 million neurons per minute. Ask your doctor why they have not contacted researchers to solve this problem. Are they OK with leaving some stroke survivors behind? Or is this ok because this person will not survive and thus your doctor has left no survivor behind?

 

Perfusion imaging and clinical outcome in acute ischemic stroke with large core

Pierre Seners PhD, Catherine Oppenheim PhD, Guillaume Turc PhD, Jean-François Albucher, Adrien Guenego, Nicolas Raposo PhD, Soren Christensen PhD, Lionel Calvière, Alain Viguier … See all authors

First published: 03 July 2021

https://doi.org/10.1002/ana.26152

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ana.26152.

Abstract

Objective

Mechanical thrombectomy (MT) is not recommended for acute stroke with large vessel occlusion (LVO) and a large volume of irreversibly injured tissue (“core”). Perfusion imaging may identify a subset of patients with large core who benefit from MT.

Methods

We compared two cohorts of LVO-related patients with large core (>50 ml on diffusion-weighted-imaging or CT-perfusion using RAPID), available perfusion imaging, and treated within 6 hrs from onset by either MT + Best Medical Management (BMM) in one prospective study, or BMM alone in the pre-MT era from a prospective registry. Primary outcome was 90-day modified Rankin Scale≤2. We searched for an interaction between treatment group and amount of penumbra as estimated by the mismatch ratio (MMRatio = critical hypoperfusion/core volume).

Results

Overall, 107 patients were included (56 MT + BMM + 51 BMM): Mean age was 68 ± 15 yrs, median core volume 99 ml (IQR: 72–131) and MMRatio 1.4 (IQR: 1.0–1.9). Baseline clinical and radiological variables were similar between the 2 groups, except for a higher intravenous thrombolysis rate in the BMM group. The MMRatio strongly modified the clinical outcome following MT (P_interaction < 0.001 for continuous MMRatio); MT was associated with a higher rate of good outcome in patients with, but not in those without, MMRatio>1.2 (adjusted OR [95%CI] = 6.8 [1.7–27.0] vs. 0.7 [0.1–6.2], respectively). Similar findings were present for MMRatio≥1.8 in the subgroup with core≥70 ml. Parenchymal hemorrhage on follow-up imaging was more frequent in the MT + BMM group regardless of the MMRatio.

Interpretation

Perfusion imaging may help select which patients with large core should be considered for MT. Randomized studies are warranted.

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