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

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BACKGROUND AND PURPOSE 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). METHODS 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. RESULTS 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. CONCLUSIONS 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)

Division/Institute:

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; Hsieh, Kety Wha-Vei; Slotboom, Johannes; Heldner, Mirjam Rachel; Broeg-Morvay, Anne; Mono, Marie-Luise; Fischer, Urs; Mattle, Heinrich; Arnold, Marcel; Gralla, Jan; El-Koussy, Marwan and Jung, Simon

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0039-2499

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

02 Oct 2015 09:30

Last Modified:

29 Dec 2017 09:42

Publisher DOI:

10.1161/STROKEAHA.115.010250

PubMed ID:

26251252

Uncontrolled Keywords:

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

BORIS DOI:

10.7892/boris.72086

URI:

https://boris.unibe.ch/id/eprint/72086

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