Document Detail

Patients with the malignant profile within 3 hours of symptom onset have very poor outcomes after intravenous tissue-type plasminogen activator therapy.
MedLine Citation:
PMID:  22811464     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: The malignant profile has been associated with poor outcomes after reperfusion in the 3- to 6-hour time window. The aim of this study was to estimate the incidence and prognostic implications of the malignant profile, as identified by CT perfusion, in intravenous tissue-type plasminogen activator-treated patients who were imaged <3 hours from stroke onset.
METHODS: The incidence of the malignant profile, based on the previously published optimal perfusion-weighted imaging definition, was assessed in consecutive patients using a fully automated software program (RApid processing of Perfusion and Diffusion [RAPID]). A receiver operating characteristic curve analysis was done to identify time to maximum and core volume thresholds that optimally identify patients with poor outcome (modified Rankin Scale 5-6).
RESULTS: Forty-two patients had an interpretable CT perfusion performed within 3 hours of symptom onset. Mean age was 74±14 years and median (interquartile range) National Institutes of Stroke Scale score was 13 (6-19). Four patients (9.5%) met the prespecified criteria for the malignant profile and all 4 had poor outcome. Receiver operating characteristic analysis determined that the best CT perfusion measure to identify patients with poor outcome was a cerebral blood flow based infarct core >53 mL (100% specificity and 67% sensitivity). This criterion identified 5 patients as malignant (12%). The poor outcome rate in these patients was 100% versus 7.1% in the 37 nonmalignant patients (P<0.001).
CONCLUSIONS: The incidence of the malignant profile on CT perfusion is approximately 10% in tissue-type plasminogen activator-eligible patients imaged within 3 hours of symptom onset. The clinical outcome of these patients is very poor despite intravenous tissue-type plasminogen activator therapy.
Manabu Inoue; Michael Mlynash; Matus Straka; Maarten G Lansberg; Greg Zaharchuk; Roland Bammer; Gregory W Albers
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Publication Detail:
Type:  Journal Article     Date:  2012-07-17
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  43     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-28     Completed Date:  2012-11-05     Revised Date:  2014-06-17    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2494-6     Citation Subset:  IM    
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MeSH Terms
Cerebral Infarction / drug therapy,  pathology
Fibrinolytic Agents / administration & dosage,  therapeutic use*
Image Processing, Computer-Assisted
Magnetic Resonance Imaging
Middle Aged
ROC Curve
Stroke / drug therapy*,  physiopathology*
Tissue Plasminogen Activator / administration & dosage,  therapeutic use*
Tomography, X-Ray Computed
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Fibrinolytic Agents; EC Plasminogen Activator

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