Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment.

Gilgen, Marc; Klimek, Dariusz Dawid; Liesirova, Kai Timo; Meisterernst, Julia Anne; Klinger-Gratz, Pascal P; Schroth, Gerhard; Mordasini, Pasquale; Hsieh, Kety Wha-Vei; Slotboom, Johannes; Heldner, Mirjam Rachel; Broeg-Morvay, Anne; Mono, Marie-Luise; Fischer, Urs; Mattle, Heinrich P.; Arnold, Marcel; Gralla, Jan; El-Koussy, Marwan; Jung, Simon (2015). Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment. Stroke, 46(9), pp. 2510-2516. Lippincott Williams & Wilkins 10.1161/STROKEAHA.115.010250

[img] Text
2510.full.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (692kB) | Request a copy


Lesion volume on diffusion-weighted magnetic resonance imaging (DWI) before acute stroke therapy is a predictor of outcome. Therefore, patients with large volumes are often excluded from therapy. The aim of this study was to analyze the impact of endovascular treatment in patients with large DWI lesion volumes (>70 mL).


Three hundred seventy-two patients with middle cerebral or internal carotid artery occlusions examined with magnetic resonance imaging before treatment since 2004 were included. Baseline data and 3 months outcome were recorded prospectively. DWI lesion volumes were measured semiautomatically.


One hundred five patients had lesions >70 mL. Overall, the volume of DWI lesions was an independent predictor of unfavorable outcome, survival, and symptomatic intracerebral hemorrhage (P<0.001 each). In patients with DWI lesions >70 mL, 11 of 31 (35.5%) reached favorable outcome (modified Rankin scale score, 0-2) after thrombolysis in cerebral infarction 2b-3 reperfusion in contrast to 3 of 35 (8.6%) after thrombolysis in cerebral infarction 0-2a reperfusion (P=0.014). Reperfusion success, patient age, and DWI lesion volume were independent predictors of outcome in patients with DWI lesions >70 mL. Thirteen of 66 (19.7%) patients with lesions >70 mL had symptomatic intracerebral hemorrhage with a trend for reduced risk with avoidance of thrombolytic agents.


There was a growing risk for poor outcome and symptomatic intracerebral hemorrhage with increasing pretreatment DWI lesion volumes. Nevertheless, favorable outcome was achieved in every third patient with DWI lesions >70 mL after successful endovascular reperfusion, whereas after poor or failed reperfusion, outcome was favorable in only every 12th patient. Therefore, endovascular treatment might be considered in patients with large DWI lesions, especially in younger patients.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Gilgen, Marc, Klimek, Dariusz Dawid, Liesirova, Kai Timo, Meisterernst, Julia Anne, Schroth, Gerhard, Mordasini, Pasquale Ranato, Hsieh, Kety Wha-Vei, Slotboom, Johannes, Heldner, Mirjam Rachel, Broeg-Morvay, Anne, Mono, Marie-Luise, Fischer, Urs Martin, Mattle, Heinrich, Arnold, Marcel, Gralla, Jan, El-Koussy, Marwan, Jung, Simon


600 Technology > 610 Medicine & health




Lippincott Williams & Wilkins




Valentina Rossetti

Date Deposited:

02 Oct 2015 09:30

Last Modified:

02 Mar 2023 23:26

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

carotid artery internal; cerebral hemorrhage; diffusion; endovascular therapy; magnetic resonance imaging; reperfusion; stroke




Actions (login required)

Edit item Edit item
Provide Feedback