Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke

Brice Ozenne, Tae-Hee Cho, Irene Klaerke Mikkelsen, Marc Hermier, Lars Ribe, Götz Thomalla, Salvador Pedraza, Jean-Claude Baron, Pascal Roy, Yves Berthezène, Norbert Nighoghossian, Leif Østergaard, Delphine Maucort-Boulch

Research output: Contribution to journalJournal articleResearchpeer-review

2 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Though still debated, early reperfusion is increasingly used as a biomarker for clinical outcome. However, the lack of a standard definition hinders the assessment of reperfusion therapies and study comparisons. The objective was to determine the optimal early reperfusion criteria that predicts clinical outcome in ischemic stroke.

METHODS: Early reperfusion was assessed voxel-wise in 57 patients within 6 hours of symptom onset. The performance of the time to peak (TTP), the mean transit time (MTT), and the time to maximum of residue function (Tmax ) at various delays thresholds in predicting the neurological response (based on the National Institutes of Health Stroke Scale) and the functional outcome (modified Rankin scale ≤1) at 1 month were compared. A receiver operating characteristics (ROC) analysis determined the optimal extent of reperfusion. A novel unsupervised classification of reperfusion using group-based trajectory modeling (GBTM) was evaluated.

RESULTS: MTT had a lower performance than TTP and Tmax in predicting the neurological response (P = .008 vs. TTP and P = .006 vs. Tmax ) or the functional outcome (P = .0006 vs. TTP; P = .002 vs. Tmax ). No delay threshold had a significantly higher predictive value than another. The optimal percentage of reperfusion was dependent on the outcome scale (P < .001). The GBTM-based classification of reperfusion was closely associated with the clinical outcome and had a similar accuracy compared to ROC-based classification.

CONCLUSIONS: TTP and Tmax should be preferred to MTT in defining early reperfusion. GBTM provided a clinically relevant reperfusion classification that does not require prespecified delay thresholds or clinical outcomes.

Original languageEnglish
JournalJournal of Neuroimaging
Volume25
Issue number6
Pages (from-to)952-958
Number of pages7
ISSN1051-2284
DOIs
Publication statusPublished - Nov 2015
Externally publishedYes

Keywords

  • Journal Article
  • Research Support, Non-U.S. Gov't

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