Perfusion Imaging and Clinical Outcome in Acute Minor Stroke With Large Vessel Occlusion.

Seners, Pierre; Arquizan, Caroline; Fontaine, Louis; Ben Hassen, Wagih; Heldner, Mirjam R; Strambo, Davide; Nagel, Simon; Carrera, Emmanuel; Mechtouff, Laura; McCullough-Hicks, Margy; Mohammaden, Mahmoud H; Cottier, Jean-Philippe; Henon, Hilde; Aignatoaie, Andreea; Laksiri, Nadia; Papassin, Jérémie; Lucas, Ludovic; Garnier, Pierre; Triquenot, Aude; Mione, Gioia; ... (2022). Perfusion Imaging and Clinical Outcome in Acute Minor Stroke With Large Vessel Occlusion. Stroke, 53(11), pp. 3429-3438. American Heart Association 10.1161/STROKEAHA.122.039182

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BACKGROUND

Whether bridging therapy (intravenous thrombolysis [IVT] followed by mechanical thrombectomy) is superior to IVT alone in minor stroke with large vessel occlusion is unknown. Perfusion imaging may identify subsets of large vessel occlusion-related minor stroke patients with distinct response to bridging therapy.

METHODS

We conducted a multicenter international observational study of consecutive IVT-treated patients with minor stroke (National Institutes of Health Stroke Scale score ≤5) who had an anterior circulation large vessel occlusion and perfusion imaging performed before IVT, with a subset undergoing immediate thrombectomy. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month modified Rankin Scale score 0 to 1. We searched for an interaction between treatment group and mismatch volume (critical hypoperfusion-core volume).

RESULTS

Overall, 569 patients were included (172 and 397 in the bridging therapy and IVT groups, respectively). After propensity-score weighting, the distribution of baseline variables was similar across the 2 groups. In the entire population, bridging was associated with lower odds of achieving modified Rankin Scale score 0 to 1: odds ratio, 0.73 [95% CI, 0.55-0.96]; P=0.03. However, mismatch volume modified the effect of bridging on clinical outcome (Pinteraction=0.04 for continuous mismatch volume); bridging was associated with worse outcome in patients with, but not in those without, mismatch volume <40 mL (odds ratio, [95% CI] for modified Rankin Scale score 0-1: 0.48 [0.33-0.71] versus 1.14 [0.76-1.71], respectively). Bridging was associated with higher incidence of symptomatic intracranial hemorrhage in the entire population, but this effect was present in the small mismatch subset only (Pinteraction=0.002).

CONCLUSIONS

In our population of large vessel occlusion-related minor stroke patients, bridging therapy was associated with lower rates of good outcome as compared with IVT alone. However, mismatch volume was a strong modifier of the effect of bridging therapy over IVT alone, notably with worse outcome with bridging therapy in patients with mismatch volume ≤40 mL. Randomized trials should consider adding perfusion imaging for patient selection.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology 04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
UniBE Contributor:	Heldner, Mirjam Rachel, Mordasini, Pasquale Ranato
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1524-4628
Publisher:	American Heart Association
Language:	English
Submitter:	Pubmed Import
Date Deposited:	25 Jul 2022 10:13
Last Modified:	02 Mar 2023 23:36
Publisher DOI:	10.1161/STROKEAHA.122.039182
PubMed ID:	35862225
Uncontrolled Keywords:	incidence odds ratio perfusion imaging propensity score thrombectomy
URI:	https://boris.unibe.ch/id/eprint/171465