Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue
Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue
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DOI：
10.1212/wnl.0000000000001853
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发表时间：
2015-08-25
期刊：
影响因子：
9.9
通讯作者：
Albers, Gregory W.
中科院分区：
文献类型：
--
作者：
Lansberg, Maarten G.;Cereda, Carlo W.;Albers, Gregory W.
目的：评估治疗时间是否会改变中风患者血管内再灌注的效果，并有 MRI 上可挽救组织的证据。方法：纳入来自用于了解中风演变 2 的弥散和灌注成像评估 (DEFUSE 2) 队列研究的灌注-弥散目标不匹配的患者。再灌注定义为灌注病变体积在基线和早期随访之间减少至少 50%。良好的功能结果定义为第 90 天时的改良 Rankin 量表评分 2。病灶生长定义为基线与早期随访弥散加权成像病灶体积之间的差异。结果：在 78 名目标不匹配的患者中（平均年龄 66-16 岁，54% 女性），再灌注与良好功能结果的几率增加相关（调整优势比 3.7，95% 置信区间） 1.2-12，p = 0.03）和病变生长减弱（p = 0.02）。治疗时间不会改变这些效应（对于良好的功能结果，时间 x 再灌注相互作用的 p 值为 0.6，对于病变生长，p 值为 0.3）。同样，在再灌注患者亚组中 (n = 46)，治疗时间与良好的功能结果无关 (p = 0.2)。结论：对于灌注-扩散不匹配的患者，血管内再灌注与功能和影像学结果改善之间的关联不依赖于时间。错配患者在晚期时间窗口从血管内治疗中获益的证据应该来自随机安慰剂对照试验。
Objective:To evaluate whether time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on MRI.Methods:Patients from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) cohort study with a perfusion-diffusion target mismatch were included. Reperfusion was defined as a decrease in the perfusion lesion volume of at least 50% between baseline and early follow-up. Good functional outcome was defined as a modified Rankin Scale score 2 at day 90. Lesion growth was defined as the difference between the baseline and the early follow-up diffusion-weighted imaging lesion volumes.Results:Among 78 patients with the target mismatch profile (mean age 66 16 years, 54% women), reperfusion was associated with increased odds of good functional outcome (adjusted odds ratio 3.7, 95% confidence interval 1.2-12, p = 0.03) and attenuation of lesion growth (p = 0.02). Time to treatment did not modify these effects (p value for the time x reperfusion interaction is 0.6 for good functional outcome and 0.3 for lesion growth). Similarly, in the subgroup of patients with reperfusion (n = 46), time to treatment was not associated with good functional outcome (p = 0.2).Conclusion:The association between endovascular reperfusion and improved functional and radiologic outcomes is not time-dependent in patients with a perfusion-diffusion mismatch. Proof that patients with mismatch benefit from endovascular therapy in the late time window should come from a randomized placebo-controlled trial.