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  • Albers, Gregory W  (56)
  • 2010-2014  (56)
  • 1
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    Heterogeneity in the penumbra
    SAGE Publications ; 2011
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 31, No. 9 ( 2011-09), p. 1836-1851
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 31, No. 9 ( 2011-09), p. 1836-1851
    Abstract: Original experimental studies in nonhuman primate models of focal ischemia showed flow-related changes in evoked potentials that suggested a circumferential zone of low regional cerebral blood flow with normal K + homeostasis, around a core of permanent injury in the striatum or the cortex. This became the basis for the definition of the ischemic penumbra. Imaging techniques of the time suggested a homogeneous core of injury, while positing a surrounding ‘penumbral’ region that could be salvaged. However, both molecular studies and observations of vascular integrity indicate a more complex and dynamic situation in the ischemic core that also changes with time. The microvascular, cellular, and molecular events in the acute setting are compatible with heterogeneity of the injury within the injury center, which at early time points can be described as multiple ‘mini-cores' associated with multiple ‘mini-penumbras’. These observations suggest the progression of injury from many small foci to a homogeneous defect over time after the onset of ischemia. Recent observations with updated imaging techniques and data processing support these dynamic changes within the core and the penumbra in humans following focal ischemia.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/jcbfm.2011.93
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
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  • 2
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    Abstract TMP16: Hypoperfusion Severity Is Associated With Poor Collaterals And Progresses Over Time
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: We hypothesized that cerebral perfusion deficits are more severe in acute stroke patients with poor collaterals and that the severity would increase over time if reperfusion does not occur. Methods: This is a substudy of DEFUSE 2. Collaterals were assessed on conventional angiography and dichotomized as poor vs. good flow. DWI and PWI were performed before and within 12 hrs after endovascular therapy; PWI lesion volumes were determined using a Tmax 〉 6sec threshold. The hypoperfusion ratio (HR) was calculated by determining the proportion of the PWI lesion that had severe Tmax delay ( 〉 10sec). Acute lesion growth was defined as the difference between the baseline and follow-up DWI volume. Part 1: In patients with an ICA or M1 occlusion we compared the HR to the collateral score. An ROC curve assessed whether the HR predicts the collateral score. Part 2: Among patients who did not experience early reperfusion, the difference between the baseline and follow-up HR was assessed and correlated with early infarct growth. Results: Part 1: Fifty six patients were eligible. Poor collateral flow was associated with larger baseline PWI lesion volume, p=0.012 and a higher HR compared to patients with good flow [median HR 45% (IQR: 35-52%) vs. 34% (IQR 14-41), p=0.003]. A HR 〉 41% predicted poor collateral flow with an AUC=0.73 (sensitivity 65%, specificity 78%, p=0.003). Part 2: Thirty two patients who did not achieve reperfusion were included; PWI Tmax 〉 6sec lesions volumes at baseline and follow-up were similar (median volume 75 mL at both time points). The median HR at follow-up was significantly higher than baseline [46% IQR (34-65) vs. 40% (24-48), p=0.007; median difference = 13% (IQR: 3.5-17)]. Patients who had worsening of their HR between baseline and follow-up were more likely to experience early ischemic lesion growth (R=0.53, p=0.002). Conclusion: The size and severity of Tmax lesions are associated with angiographic collateral scores. Patients who have a high percentage of their PWI lesion comprised of severe Tmax delays are likely to have poor collaterals. When early reperfusion is not achieved, the severity of hypoperfusion progresses and this progression is associated with early infarct growth.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.ATMP16
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 3
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    Abstract 95: Regional Very Low Cerebral Blood Volume with Subsequent Local Reperfusion Predicts Hemorrhagic Transformation in Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background and Purpose Regions of very low cerebral blood volume (VLCBV) on MR perfusion imaging have been shown to predict hemorrhagic transformation (HT) following stroke thrombolysis. We tested the hypothesis that local reperfusion in a region of VLCBV is a pre-requisite for hemorrhagic transformation using pooled imaging data from the EPITHET and DEFUSE studies. Methods Standard CBV maps were calculated and smoothed (Gaussian) to reduce noise. The volume of VLCBV was calculated within the acute Tmax 〉 4sec perfusion lesion using fully automated techniques and a range of VLCBV thresholds relative to CBV values in the non-stroke hemisphere. Receiver operating characteristic (ROC) analysis was used to determine the optimal definition and threshold of VLCBV to predict parenchymal hematoma (PH, ECASS definition). Regional reperfusion was assessed using co-registered subacute Tmax perfusion images (DEFUSE 3-6hrs post thrombolysis, EPITHET 3-5 days post thrombolysis/placebo). The risk of PH associated with VLCBV was assessed with and without exclusion of regions of VLCBV within persistently hypoperfused regions. Results Of 145 patients with baseline perfusion imaging, 22 (15.2%) had PH (13 PH1, 9 PH2). A VLCBV definition of either 〈 2.5 th percentile of the contralateral CBV distribution (VLCBV 〈 2.5pctile) or 〈 15% of the mean contralateral CBV (VLCBV 〈 15%) had similar performance in predicting PH (AUC 0.73 for both). To achieve sensitivity of 95% required a VLCBV 〈 2.5pctile threshold of 〉 2mL (specificity 47%) or a VLCBV 〈 15% threshold of 〉 0.5mL (specificity 41%). There were 130 patients with subacute perfusion imaging, at which time 15 (11.5%) had developed PH. A further 3 patients (without reperfusion at subacute MRI) later developed PH and were excluded as reperfusion status at the time of PH was unknown. In the remaining 127 patients, the AUC for PH increased from 0.77 to 0.92 (p 〈 0.001, VLCBV 〈 2.5pctile definition) when regions of VLCBV without reperfusion on subacute imaging were excluded. The specificity of the 〉 2mL threshold (VLCBV 〈 2.5pctile) increased from 46 to 75%, positive predictive value increased from 20 to 35%, likelihood ratio for PH increased from 1.9 to 4.0 (sensitivity and negative predictive value were both 100% in these 127 patients). No patient developed PH at the time of subacute imaging in the absence of local reperfusion, including one patient where reperfusion of basal ganglia infarction had occurred (with CBV normalisation) prior to thrombolysis. Conclusions Local reperfusion is a critical factor in determining the risk of HT associated with regional VLCBV. This is consistent with the hypothesis that the severe ischemia represented by VLCBV is associated with focal blood-brain-barrier disruption and potential HT should reperfusion subsequently occur. Assessment of VLCBV can be automated and may be useful in clinical risk-benefit decisions regarding thrombolysis.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A95
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 4
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    Abstract 135: Correlation of TICI Reperfusion with MR Reperfusion, Infarct Growth and Clinical Outcome in the DEFUSE 2 Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: The Thrombolysis In Cerebral Infarction (TICI) score is a widely used angiographic score in endovascular stroke studies. Assessment of reperfusion based on perfusion weighted MRI (PWI reperfusion) has been used more commonly in patients treated with intravenous thrombolysis. This analysis of the DEFUSE 2 study data was undertaken to 1) determine the association between TICI and PWI reperfusion and 2) assess the association between TICI-reperfusion and clinical and radiographic outcomes. Methods: Patients undergoing acute endovascular stroke therapy of anterior circulation strokes were enrolled in a prospective multi-center study (DEFUSE 2) if an MRI could be obtained within 90 minutes before endovascular treatment and repeated within 12 hours after the intervention. Only patients with a TICI score of 0 or 1 on baseline digital subtraction angiography (DSA) were included in this analysis. A single blinded reader at the core imaging facility determined pre- and post-procedure TICI scores. TICI-reperfusion was defined as a TICI score of 2B or 3. PWI lesion volumes were assessed using fully automated software (RAPID). PWI-reperfusion was defined as a reduction in PWI(Tmax 〉 6s) lesion volume of 〉 50% between baseline and early follow-up. Infarct growth was defined as the difference between baseline DWI and 5-day FLAIR lesion volume. Favorable clinical response was defined as a NIHSS score of 0-1 at day 30 or an improvement in NIHSS score of ≥8 points between baseline and day 30. Results: This preliminary analysis includes 68 of 101 patients who underwent endovascular therapy and had adequate PWI data to assess reperfusion (final results will be presented at the meeting). At completion of endovascular treatment 30% of the patients remained TICI 0 or 1, 27% improved to TICI 2A, 29% to TICI 2B, and 13% had complete reperfusion (TICI 3). Better TICI-reperfusion scores were associated with higher rates of reperfusion assessed by PWI. PWI-reperfusion was seen in 32% of patients who remained TICI 0-1, 53% with TICI 2A, 98% with TICI 2B, and 100% with TICI 3 reperfusion. Agreement between TICI-reperfusion and PWI-reperfusion was moderate (kappa 0.51). The incidence of favorable clinical response increased with higher TICI scores: 35% with TICI 0-1, 44% with TICI 2A, 72% with TICI 2B, and 67% with TICI 3. Patients who met pre-specified DEFUSE 2 criteria for reperfusion (TICI 2B/3) were more likely to have a favorable clinical response (70% vs 40%; p=0.015), and had less median [IQR] lesion growth (10 [2-56] ml vs 67 [28-122] ml; p=0.001) than patients without TICI-reperfusion. Conclusion: TICI 2B or 3 reperfusion following endovascular therapy for acute anterior circulation stroke is highly correlated with PWI reperfusion. Patients with TICI 2B or 3 reperfusion show less infarct growth and are more likely to have a favorable clinical response.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A135
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 5
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    Abstract 73: Results of DEFUSE 2: Clinical Endpoints
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: The aim of DEFUSE 2 was to determine if there is a differential response to reperfusion following endovascular therapy according to predefined baseline MRI profiles. Methods: This prospective cohort study was conducted at 9 stroke centers. Consecutive patients, scheduled to undergo acute endovascular therapy within 12 hours of stroke onset, were enrolled if they had an NIHSSS 〉 5 and could undergo an MRI with perfusion (PWI) and diffusion-weighted imaging (DWI) immediately before the intervention. A fully automated image analysis program (RAPID) was used to determine lesion volumes. Patients were classified as Target Mismatch (TMM) if they met these criteria: a ratio of PWI(Tmax 〉 6s) over DWI volume 〉 1.8, DWI 〈 70ml, and a PWI(Tmax 〉 10s) volume 〈 100ml. An early follow-up MRI was obtained 〈 12 hours after endovascular therapy. Early reperfusion was defined as a 〉 50% reduction in Tmax 〉 6s volume between baseline and early follow-up. Favorable clinical response was defined as a ≥8 point improvement on the NIHSSS or an NIHSSS of 0-1 at 30 days. Results: This abstract represents a preliminary analysis of 86 of 101 patients who were treated with endovascular therapy (final results will be presented). The baseline characteristics of patients with TMM (n=70) were: mean age 67, median NIHSS 15, treated with iv tPA 43%, mean time from symptom onset to endovascular treatment 6.7 hrs, mean DWI volume 18 ml, and Tmax 〉 6s volume 82 ml. Early reperfusion was achieved in 64% of the TMM population and favorable clinical response was more common in TMM patients with early reperfusion than in TMM patients who did not reperfuse (69% vs 24%; p 〈 0.001). The baseline characteristics of patients without TMM (n=16) were: mean age 59, median NIHSS 19, treated with iv tPA 81%, mean time from symptom onset to endovascular treatment 5.4 hrs, mean DWI volume 76 ml, and Tmax 〉 6s volume 115 ml. Early reperfusion was achieved in 53% of the patients without TMM but was not associated with favorable clinical response in this population (44% had favorable clinical response with reperfusion vs 86% without reperfusion; p=0.15). The odds ratio for favorable clinical response associated with reperfusion was higher in TMM patients (7.0; 95% CI 2.3-21) than in those without TMM (0.1; 95% CI 0.1-1.6) (p 〈 0.01 for difference between odds ratios). These odds ratios remained similar after adjustment for differences in baseline characteristics (OR 7.8 vs. 0.2; p 〈 0.01 for difference between odds ratios). Conclusion: Early reperfusion following endovascular therapy is associated with substantial clinical benefits in patients with the Target Mismatch profile on baseline MRI. There is no association between reperfusion and favorable clinical outcomes in patients without Target Mismatch. These findings support the use of PWI/DWI selection criteria to identify a patient subgroup that is most likely to benefit from endovascular reperfusion therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A73
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 6
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    Abstract 52: Results of DEFUSE 2: Imaging Endpoints
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: The aim of DEFUSE 2 is to determine if predefined MRI profiles predict clinical and imaging outcomes following endovascular reperfusion therapy. Methods: This prospective, NIH funded, multi-center study enrolled consecutive acute stroke patients in whom an MRI scan could be obtained immediately prior to intra-arterial therapy. A follow-up MRI was performed within 12 hrs of completion of the procedure and again at 5 days. PWI and DWI lesion volumes were determined using a fully automated software program (RAPID). Lesion growth (infarct volume on 5 day FLAIR - baseline DWI volume) was compared for patients with and without the Target mismatch profile based on whether early reperfusion occurred. The Target mismatch profile was defined as PWI(Tmax 〉 6s) / DWI 〉 1.8, DWI 〈 70 mL and PWI(Tmax 〉 10s) 〈 100 mL. Early reperfusion was defined as a 〉 50% reduction in PWI volume following the procedure. The incidence and extent of DWI reversal was assessed and the fate of PWI lesions that were not reperfused was determined. Favorable clinical response was defined as an improvement in NIHSS ≥8 or 0-1 at 30 days. Results: This abstract represents a preliminary analysis of 71 of 101 patients who were treated with endovascular therapy (final results to be presented). Among the 54 patients with Target mismatch, early reperfusion was achieved in 70% and was associated with less infarct growth (relative median growth 210% vs. 450%, p=0.01) and a higher rate of favorable clinical response (OR=5.4; 95%CI 1.5-19.2). In patients without the Target mismatch profile (N= 13) early reperfusion was not associated with a reduction in infarct growth (relative median growth was 220% in both reperfusers and non-reperfusers; p=0.94) or an increased rate of favorable clinical response (OR=0.1; 95%CI 0.004-2.2). 96% of all voxels that were DWI positive at baseline were incorporated into the final infarct (assessed on the co-registered 5 day FLAIR); only 3 of 71 patients had FLAIR volumes that were smaller than the baseline DWI lesion (mean difference 3 mL). 80% of the voxels that had a PWI lesion (Tmax 〉 6s) on the post-procedure scan were incorporated into the final infarct. The correlation between the union of the baseline DWI + early follow-up PWI lesion and the 5 day FLAIR volume was high (r=0.84; p 〈 0.0001). In 82% of the patients, the day 5 FLAIR volume was as at least as large as the union of the baseline DWI + early follow-up PWI lesion. Conclusion: Patients with the Target mismatch profile who achieve early reperfusion following intra-arterial therapy have less infarct growth and more favorable clinical outcomes. In contrast, no benefit of reperfusion was evident for non-Target mismatch patients. Baseline DWI lesions are virtually always fully incorporated into the final infarct volume, regardless of reperfusion. Tissue that remains hypoperfused (Tmax 〉 6s) following endovascular therapy reliably progresses to infarction.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A52
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 7
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    Abstract 14: Predicting Hemorrhagic Transformation in Ischemic Stroke - Very Low Cerebral Blood Volume versus Permeability Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background and purpose: Hemorrhagic transformation is the major complication of reperfusion therapies and carries a high risk of disability and death. Very low cerebral blood volume (VLCBV) and increased blood brain barrier permeability, both markers of severe ischemia, have been proposed as imaging predictors of hemorrhage risk. We aimed to compare the prognostic power of these two approaches using data from the DEFUSE 2 study. Methods: Acute ischemic stroke patients had perfusion-diffusion MRI before and within 12 hr after endovascular therapy. Baseline cerebral blood volume (CBV) maps were generated and the volume of VLCBV (CBV 〈 2.5 th percentile of the normal hemisphere) was calculated. Permeability was assessed using two recirculation parameters: "relative recirculation" (rR): the difference in area encompassed by the observed tissue-concentration curve and a theoretical fit of the first pass bolus; and "percent recovery" (%Recovery): the difference in signal intensity between peak bolus and average post-bolus. Parenchymal hematoma (PH) was defined using ECASS criteria. Reperfusion was defined as 〉 50% reduction in Tmax 〉 6sec lesion volume between baseline and post-procedure MRI. Logistic regression models were compared using Bayesian Information Criterion (BIC). Results: In DEFUSE 2, MRI prior to catheter angiography was performed in 110 patients, 59 had tPA pre-treatment and 25 developed PH. In 103 patients with technically adequate acute perfusion MR, preliminary receiver operating characteristic analysis identified 〉 40%rR and 〈 50%Rec as the optimal thresholds to assess the volume of tissue with increased permeability. In logistic regression, PH was associated with increased VLCBV (p=0.02) and rR permeability (p=0.05) but not %Recovery (p=0.17). The VLCBV model had better fit than rR permeability (BIC difference +2.1) and there was no significant interaction between parameters (p=0.33). Reperfusion was strongly associated with PH (p=0.01) and improved fit of the VLCBV model (BIC +7.2). Conclusions: VLCBV was a stronger predictor of early PH after reperfusion than permeability parameters in patients treated with endovascular therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.A14
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 8
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    The Infarct Core is Well Represented by the Acute Diffusion Lesion: Sustained Reversal is Infrequent
    SAGE Publications ; 2012
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 32, No. 1 ( 2012-01), p. 50-56
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 32, No. 1 ( 2012-01), p. 50-56
    Abstract: Diffusion-weighted imaging (DWI) is commonly used to assess irreversibly infarcted tissue but its accuracy is challenged by reports of diffusion lesion reversal (DLR). We investigated the frequency and implications for mismatch classification of DLR using imaging from the EPITHET (Echoplanar Imaging Thrombolytic Evaluation Trial) and DEFUSE (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution) studies. In 119 patients (83 treated with IV tissue plasminogen activator), follow-up images were coregistered to acute diffusion images and the lesions manually outlined to their maximal visual extent in diffusion space. Diffusion lesion reversal was defined as voxels of acute diffusion lesion that corresponded to normal brain at follow-up (i.e., final infarct, leukoaraiosis, and cerebrospinal fluid (CSF) voxels were excluded from consideration). The appearance of DLR was visually checked for artifacts, the volume calculated, and the impact of adjusting baseline diffusion lesion volume for DLR volume on perfusion-diffusion mismatch analyzed. Median DLR volume reduced from 4.4 to 1.5 mL after excluding CSF/leukoaraiosis. Visual inspection verified 8/119 (6.7%) with true DLR, median volume 2.33 mL. Subtracting DLR from acute diffusion volume altered perfusion—diffusion mismatch ( T max 〉 6 seconds, ratio 〉 1.2) in 3/119 (2.5%) patients. Diffusion lesion reversal between baseline and 3 to 6 hours DWI was also uncommon (7/65, 11%) and often transient. Clinically relevant DLR is uncommon and rarely alters perfusion—diffusion mismatch. The acute diffusion lesion is generally a reliable signature of the infarct core.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/jcbfm.2011.102
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
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  • 9
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    MR RESCUE : Is the Glass Half-Full or Half-Empty?
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 7 ( 2013-07), p. 2055-2057
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 7 ( 2013-07), p. 2055-2057
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.001443
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 10
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    Abstract 53: The Malignant MRI profile: Implications for Endovascular Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: The Malignant MRI profile identifies stroke patients with poor outcomes and an increased incidence of parenchymal hematoma following iv thrombolysis; outcomes following endovascular reperfusion therapy have not been described. Methods: The NIH funded DEFUSE 2 trial enrolled consecutive acute stroke patients in whom endovascular therapy was anticipated. An MRI scan was obtained immediately prior to intra-arterial reperfusion therapy, then repeated following the procedure and on day 5. Perfusion-weighted (PWI) and diffusion-weighted imaging (DWI) maps were created and lesion volumes estimated with an automated software program (RAPID). In the DEFUSE 2, the Malignant profile was pre-specified as a DWI lesion ≥70mL and/or a PWI lesion based on Tmax 〉 10sec threshold (Tmax 〉 10s) ≥100mL. A receiver operating characteristic (ROC) curve analysis was performed to identify Tmax 〉 10s and DWI volumes that predicted poor outcome (defined as a mRS 5-6 at 30 days) with a high specificity. Patients with an M1 or ICA occlusion who did not undergo endovascular therapy based on local site criteria were also included in the ROC analysis. Results: We report a preliminary analysis of the DEFUSE 2 database (full data will be presented at the meeting). One hundred and one patients were triaged to the cath lab for endovascular therapy. Of the 83 patients who had adequate data available for this analysis, 9 (11%) met the predefined criteria for the Malignant profile. 56% of the Malignant patients had poor outcome compared with 30% of the non-Malignant cases (p=0.14). Malignant patients had an increased risk of parenchymal hematoma (PH1 or PH2): 44% vs. 14% (p=0.04). Only 1 of the Malignant patients achieved a mRS of 0-2 at 30 days. Early reperfusion was obtained in 6 of the 9 Malignant patients but was not associated with an increase in favorable clinical outcome or a decrease in the risk of poor outcome. Fifteen patients with an M1 or ICA occlusion did not undergo endovascular therapy based on local site criteria. Ten of these patients had the Malignant profile and 8 of these 10 had a poor outcome. ROC curve analysis identified a DWI lesion of 112 mL and a Tmax 〉 10s lesion of 116 mL as optimal thresholds to predict poor outcome; both achieved a specificity of 98% and sensitivities of 27% and 24% respectively. 81% (13/16) of the Malignant patients identified by the DWI and/or Tmax 〉 10s optimal thresholds had poor outcome. Conclusion: Patients with large baseline DWI and/or large severe PWI lesions are likely to have poor outcomes with or without endovascular reperfusion therapy. Automated imaging software can identify these patients rapidly.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A53
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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