| Pretreatment diffusion- and perfusion-MR lesion volumes have a crucial influence on clinical response to stroke thrombolysis. | |
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MedLine Citation:
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PMID: 20087363 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We hypothesized that pretreatment magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) lesion volumes may have influenced clinical response to thrombolysis in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). In 98 patients randomized to intravenous (IV) tissue plasminogen activator (tPA) or placebo 3 to 6 h after stroke onset, we examined increasing acute DWI and PWI lesion volumes (Tmax-with 2-sec delay increments), and increasing PWI/DWI mismatch ratios, on the odds of both excellent (modified Rankin Scale (mRS): 0 to 1) and poor (mRS: 5 to 6) clinical outcome. Patients with very large PWI lesions (most had internal carotid artery occlusion) had increased odds ratio (OR) of poor outcome with IV-tPA (58% versus 25% placebo; OR=4.13, P=0.032 for Tmax +2-sec volume >190 mL). Excellent outcome from tPA treatment was substantially increased in patients with DWI lesions <18 mL (77% versus 18% placebo, OR=15.0, P<0.001). Benefit from tPA was also seen with DWI lesions up to 25 mL (69% versus 29% placebo, OR=5.5, P=0.03), but not for DWI lesions >25 mL. In contrast, increasing mismatch ratios did not influence the odds of excellent outcome with tPA. Clinical responsiveness to IV-tPA, and stroke outcome, depends more on baseline DWI and PWI lesion volumes than the extent of perfusion-diffusion mismatch. |
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Authors:
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Mark W Parsons; Soren Christensen; Patrick McElduff; Christopher R Levi; Ken S Butcher; Deidre A De Silva; Martin Ebinger; P Alan Barber; Christopher Bladin; Geoffrey A Donnan; Stephen M Davis; |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2010-01-20 |
Journal Detail:
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Title: Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism Volume: 30 ISSN: 1559-7016 ISO Abbreviation: J. Cereb. Blood Flow Metab. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-01 Completed Date: 2010-06-17 Revised Date: 2011-07-28 |
Medline Journal Info:
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Nlm Unique ID: 8112566 Medline TA: J Cereb Blood Flow Metab Country: United States |
Other Details:
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Languages: eng Pagination: 1214-25 Citation Subset: IM |
Affiliation:
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Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia. mark.parsons@hnehealth.nsw.gov.au |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Carotid Artery Diseases / drug therapy, mortality, radiography Carotid Artery, Internal / radiography Diffusion Magnetic Resonance Imaging Double-Blind Method Female Fibrinolytic Agents / therapeutic use* Humans Infusions, Intravenous Magnetic Resonance Angiography Male Middle Aged Prospective Studies Stroke / drug therapy*, mortality, radiography* Thrombolytic Therapy* Tissue Plasminogen Activator / therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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