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Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Brice Ozenne
  • ,
  • Tae-Hee Cho
  • ,
  • Irene Klaerke Mikkelsen
  • Marc Hermier
  • ,
  • Lars Ribe, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Denmark
  • Götz Thomalla
  • ,
  • Salvador Pedraza
  • ,
  • Jean-Claude Baron
  • ,
  • Pascal Roy
  • ,
  • Yves Berthezène
  • ,
  • Norbert Nighoghossian
  • ,
  • Leif Østergaard
  • Delphine Maucort-Boulch

BACKGROUND AND PURPOSE: Though still debated, early reperfusion is increasingly used as a biomarker for clinical outcome. However, the lack of a standard definition hinders the assessment of reperfusion therapies and study comparisons. The objective was to determine the optimal early reperfusion criteria that predicts clinical outcome in ischemic stroke.

METHODS: Early reperfusion was assessed voxel-wise in 57 patients within 6 hours of symptom onset. The performance of the time to peak (TTP), the mean transit time (MTT), and the time to maximum of residue function (Tmax ) at various delays thresholds in predicting the neurological response (based on the National Institutes of Health Stroke Scale) and the functional outcome (modified Rankin scale ≤1) at 1 month were compared. A receiver operating characteristics (ROC) analysis determined the optimal extent of reperfusion. A novel unsupervised classification of reperfusion using group-based trajectory modeling (GBTM) was evaluated.

RESULTS: MTT had a lower performance than TTP and Tmax in predicting the neurological response (P = .008 vs. TTP and P = .006 vs. Tmax ) or the functional outcome (P = .0006 vs. TTP; P = .002 vs. Tmax ). No delay threshold had a significantly higher predictive value than another. The optimal percentage of reperfusion was dependent on the outcome scale (P < .001). The GBTM-based classification of reperfusion was closely associated with the clinical outcome and had a similar accuracy compared to ROC-based classification.

CONCLUSIONS: TTP and Tmax should be preferred to MTT in defining early reperfusion. GBTM provided a clinically relevant reperfusion classification that does not require prespecified delay thresholds or clinical outcomes.

Original languageEnglish
JournalJournal of Neuroimaging
Volume25
Issue6
Pages (from-to)951-8
Number of pages8
ISSN1051-2284
DOIs
Publication statusPublished - 1 Nov 2015

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