MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study.
MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study.
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DOI：
10.1016/s1474-4422(12)70203-x
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发表时间：
2012-10
期刊：
影响因子：
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通讯作者：
DEFUSE 2 study investigators
中科院分区：
文献类型：
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作者：
Lansberg MG;Straka M;Kemp S;Mlynash M;Wechsler LR;Jovin TG;Wilder MJ;Lutsep HL;Czartoski TJ;Bernstein RA;Chang CW;Warach S;Fazekas F;Inoue M;Tipirneni A;Hamilton SA;Zaharchuk G;Marks MP;Bammer R;Albers GW;DEFUSE 2 study investigators
由于缺乏来自随机安慰剂对照试验的数据，尚不确定血管内卒中治疗是否能改善临床结果。这项研究的目的是确定MRI是否可以用来确定最有可能从血管内再灌注中受益的患者。计划在卒中发病后12小时内接受血管内治疗的连续患者参加了一项多中心前瞻性队列研究。在自动图像分析软件程序的帮助下，研究人员解释了基线MRI。在血管内治疗之前，他们确定患者是否有MRI特征(靶点不匹配)，这表明存在可挽救的组织。再灌注在早期的随诊MRI上被评估，并被定义为基线灌注损伤体积减少50%。良好的临床反应被定义为在基线到第30天期间，美国国立卫生研究院卒中评分(NIHSS)上的≥8分的改善，或在第30天的NIHSS评分为0-1。血管内治疗后，78例靶点不匹配患者中有46例(59%)发生再通，21例无靶点不匹配患者中有12例(57%)发生再通。与再通相关的良好临床反应的调整优势比，靶错配组为8.5(95%CI 2·6-28)，非靶错配组为0.2(95%CI 0·0-1·6)(优势比差值p=0.003)。在靶错配组中，再通与90天后良好功能结果的几率增加(OR为5.2，95%可信区间1.4-19)和5天后梗死增长的减弱(再灌注组的中位数增长30毫升与未再通组的73毫升，p=0.01)有关，但在没有靶错配组的患者中没有相关性。血管内治疗后早期再通的靶点不匹配患者有更好的临床结果和较少的梗塞扩大。在没有靶点失配的患者中，再通和良好的结果之间没有相关性。这些数据支持对靶基因不匹配患者进行血管内治疗的随机对照试验。
It is uncertain if endovascular stroke therapy leads to improved clinical outcomes due to a paucity of data from randomized placebo-controlled trials. The aim of this study was to determine if MRI can be used to identify patients who are most likely to benefit from endovascular reperfusion. Consecutive patients, scheduled to undergo endovascular therapy within 12 hours of stroke onset, were enrolled in a multi-center prospective cohort study. Aided by an automated image analysis software program, investigators interpreted the baseline MRI. They determined, prior to endovascular treatment, if the patient had an MRI profile (Target Mismatch) that suggested salvageable tissue was present. Reperfusion was assessed on an early follow-up MRI and defined as a >50% reduction in the volume of the baseline perfusion lesion. A favorable clinical response was defined as a ≥8 point improvement on the NIH Stroke Scale (NIHSS) between baseline and day 30 or an NIHSS score of 0–1 at 30 days. Following endovascular therapy reperfusion occurred in 46 of 78 (59%) Target Mismatch patients and in 12 of 21 (57%) No Target Mismatch patients. The adjusted odds ratio for favorable clinical response associated with reperfusion was 8·5 (95% CI 2·6 – 28) in the Target Mismatch group and 0·2 (95% CI 0·0 – 1·6) in the No Target Mismatch group (p=0·003 for difference between odds ratios). Reperfusion was associated with an increased odds of good functional outcome at 90 days (OR is 5.2, 95% CI 1.4–19) and attenuation of infarct growth at 5 days (30 ml of median growth with reperfusion vs. 73 ml without reperfusion, p=0·01) in the Target Mismatch group but not in patients without Target Mismatch. Target Mismatch patients who achieved early reperfusion following endovascular stroke therapy had more favorable clinical outcomes and less infarct growth. No association between reperfusion and favorable outcomes was present in patients without Target Mismatch. These data support a randomized controlled trial of endovascular treatment in patients with the Target Mismatch profile.