- Title
- Clinical-diffusion mismatch and benefit from thrombolysis 3 to 6 hours after acute stroke
- Creator
- Ebinger, Martin; Iwanaga, Takeshi; Donnan, Geoffrey A.; Davis, Stephen M.; Prosser, Jane F.; De Silva, Deidre A.; Christensen, Soren; Collins, Marnie; Parsons, Mark W.; Levi, Christopher R.; Bladin, Christopher F.; Barber, P. Alan
- Relation
- Stroke Vol. 40, Issue 7, p. 2572-2574
- Publisher Link
- http://dx.doi.org/10.1161/strokeaha.109.548073
- Publisher
- American Heart Association
- Resource Type
- journal article
- Date
- 2009
- Description
- Background and purpose: The clinical-diffusion mismatch (CDM) model has been proposed as a simpler tool than perfusion-diffusion mismatch (PDM) to select acute ischemic stroke patients for thrombolytic therapy. We hypothesized that in the 3- to 6-hour time window, the effect of tPA was significantly greater in patients with CDM than in patients without CDM. Methods: This is a substudy of EPITHET, a double-blind multi-center study of 100 patients randomized to tPA or placebo 3 to 6 hours after stroke onset. MRI was obtained before treatment, and at 3 to 5 days and 90 days after treatment. Presence of PDM (perfusion deficit/DWI volume >1.2 and perfusion deficit at least 10 mL>DWI volume) and CDM (NIHSS ≥8 and DWI volume ≤25 mL) was determined for each patient. We assessed lesion growth and neurological improvement (decrease in NIHSS ≥8 points between baseline and 90 days, or a 90-day NIHSS ≤1). Results: 86% of the patients had PDM, but only 41% had CDM. CDM detected PDM with a sensitivity of 46% and a specificity of 86%. We found statistically significant effects of reperfusion on the rate of neurological improvement (OR 9.92, 95% CI 1.91 to 51.64; P<0.01) and on absolute growth (difference: –59.60 mL, 95% CI –95.40 mL to –23.81 mL; P<0.01). Neither treatment with tPA nor reperfusion had a significantly different impact on lesion growth or clinical course in CDM patients compared to patients without CDM. Conclusions: There was no increased benefit from tPA in patients with CDM. The beneficial effects of reperfusion were similar in patients with and without CDM.
- Subject
- MRI; stroke; tPA; clinical-diffusion mismatch
- Identifier
- uon:7458
- Identifier
- http://hdl.handle.net/1959.13/807625
- Identifier
- ISSN:0039-2499
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