- Title
- What is the “optimal” target mismatch criteria for acute ischemic stroke?
- Creator
- Chen, Chushuang; Parsons, Mark W.; Avivi, Richard I.; Krause, Martin; Sylaja, P. N.; Choi, Philip; Bhuta, Sandeep; Yin, Congguo; Yang, Jianhong; Wang, Peng; Qiu, Weiwen; Bivard, Andrew; Levi, Christopher R.; Spratt, Neil J.; Lin, L; Kleinig, Timothy; Butcher, Kenneth; Cheng, Xin; Dong, Qiang; O'Brien, Billy
- Relation
- NHMRC.APP1110629 http://purl.org/au-research/grants/nhmrc/1110629
- Relation
- Frontiers in Neurology Vol. 11, Issue January 2021, no. 590766
- Publisher Link
- http://dx.doi.org/10.3389/fneur.2020.590766
- Publisher
- Frontiers Research Foundation
- Resource Type
- journal article
- Date
- 2021
- Description
- We aimed to compare Perfusion Imaging Mismatch (PIM) and Clinical Core Mismatch (CCM) criteria in ischemic stroke patients to identify the effect of these criteria on selected patient population characteristics and clinical outcomes. Patients from the INternational Stroke Perfusion Imaging REgistry (INSPIRE) who received reperfusion therapy, had pre-treatment multimodal CT, 24-h imaging, and 3 month outcomes were analyzed. Patients were divided into 3 cohorts: endovascular thrombectomy (EVT), intravenous thrombolysis alone with large vessel occlusion (IVT-LVO), and intravenous thrombolysis alone without LVO (IVT-nonLVO). Patients were classified using 6 separate mismatch criteria: PIM-using 3 different measures to define the perfusion deficit (Delay Time, Tmax, or Mean Transit Time); or CCM-mismatch between age-adjusted National Institutes of Health Stroke Scale and CT Perfusion core, defined as relative cerebral blood flow <30% within the perfusion deficit defined in three ways (as above). We assessed the eligibility rate for each mismatch criterion and its ability to identify patients likely to respond to treatment. There were 994 patients eligible for this study. PIM with delay time (PIM-DT) had the highest inclusion rate for both EVT (82.7%) and IVT-LVO (79.5%) cohorts. In PIM positive patients who received EVT, recanalization was strongly associated with achieving an excellent outcome at 90-days (e.g., PIM-DT: mRS 0-1, adjusted OR 4.27, P = 0.005), whereas there was no such association between reperfusion and an excellent outcome with any of the CCM criteria (all p > 0.05). Notably, in IVT-LVO cohort, 58.2% of the PIM-DT positive patients achieved an excellent outcome compared with 31.0% in non-mismatch patients following successful recanalization (P = 0.006).
- Subject
- ischemic stroke; stroke; perfusion; target mismatch; intravenous thrombolysis; endovascular thrombectomy; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1449486
- Identifier
- uon:43675
- Identifier
- ISSN:1664-2295
- Rights
- © 2021 Chen, Parsons, Levi, Spratt, Lin, Kleinig, Butcher, Cheng, Dong, O'Brien, Avivi, Krause, Sylaja, Choi, Bhuta, Yin, Yang, Wang, Qiu and Bivard. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
- Language
- eng
- Full Text
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