학술논문
Penumbra Consumption Rates Based on Time-to-Maximum Delay and Reperfusion Status: A Post Hoc Analysis of the DEFUSE 3 Trial.
Document Type
Academic Journal
Author
Yaghi S; Department of Neurology (S.Y., R.M., M.J.), Brown University, Providence, RI.; Raz E; Department of Radiology (E.R., S.D.), NYU Langone Health.; Dehkharghani S; Department of Radiology (E.R., S.D.), NYU Langone Health.; Department of Neurology (S.D.), NYU Langone Health.; Riina H; Department of Neurosurgery (H.R.), NYU Langone Health.; McTaggart R; Department of Neurology (S.Y., R.M., M.J.), Brown University, Providence, RI.; Department of Radiology (R.M., M.J.), Brown University, Providence, RI.; Department of Neurosurgery (R.M., M.J.), Brown University, Providence, RI.; Jayaraman M; Department of Neurology (S.Y., R.M., M.J.), Brown University, Providence, RI.; Department of Radiology (R.M., M.J.), Brown University, Providence, RI.; Department of Neurosurgery (R.M., M.J.), Brown University, Providence, RI.; Prabhakaran S; Department of Neurology, University of Chicago, IL (S.P.).; Liebeskind DS; Department of Neurology, University of California at Los Angeles (D.S.L.).; Khatri P; Department of Neurology, University of Cincinnati, OH (P.K.).; Mac Grory B; Department of Neurology, Duke University, Durham, NC (B.M.G.).; Al-Mufti F; Department of Neurology, New York Medical College, Valhalla (F.A.-M.).; Lansberg M; Department of Neurology, Stanford University, San Francisco, CA (M.L., G.A.).; Albers G; Department of Neurology, Stanford University, San Francisco, CA (M.L., G.A.).; de Havenon A; Department of Neurology, University of Utah, Salt Lake City (A.d.H.).
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0235266 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4628 (Electronic) Linking ISSN: 00392499 NLM ISO Abbreviation: Stroke Subsets: MEDLINE
Subject
Language
English
Abstract
Background and Purpose: In patients with acute large vessel occlusion, the natural history of penumbral tissue based on perfusion time-to-maximum (T max ) delay is not well established in relation to late-window endovascular thrombectomy. In this study, we sought to evaluate penumbra consumption rates for T max delays in patients with large vessel occlusion evaluated between 6 and 16 hours from last known normal.
Methods: This is a post hoc analysis of the DEFUSE 3 trial (The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke), which included patients with an acute ischemic stroke due to anterior circulation occlusion within 6 to 16 hours of last known normal. The primary outcome is percentage penumbra consumption, defined as (24-hour magnetic resonance imaging infarct volume-baseline core infarct volume)/(Tmax 6 or 10 s volume-baseline core volume). We stratified the cohort into 4 categories based on treatment modality and Thrombolysis in Cerebral Infarction (TICI score; untreated, TICI 0-2a, TICI 2b, and TICI3) and calculated penumbral consumption rates in each category.
Results: We included 141 patients, among whom 68 were untreated. In the untreated versus TICI 3 patients, a median (interquartile range) of 53.7% (21.2%-87.7%) versus 5.3% (1.1%-14.6%) of penumbral tissue was consumed based on Tmax >6 s ( P <0.001). In the same comparison for T max >10 s, we saw a difference of 165.4% (interquartile range, 56.1%-479.8%) versus 25.7% (interquartile range, 3.2%-72.1%; P <0.001). Significant differences were not demonstrated between untreated and TICI 0-2a patients for penumbral consumption based on T max >6 s ( P =0.52) or T max >10 s ( P =0.92).
Conclusions: Among extended window endovascular thrombectomy patients, Tmax >10-s mismatch volume may comprise large volumes of salvageable tissue, whereas nearly half the T max >6-s mismatch volume may remain viable in untreated patients at 24 hours.
Methods: This is a post hoc analysis of the DEFUSE 3 trial (The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke), which included patients with an acute ischemic stroke due to anterior circulation occlusion within 6 to 16 hours of last known normal. The primary outcome is percentage penumbra consumption, defined as (24-hour magnetic resonance imaging infarct volume-baseline core infarct volume)/(T
Results: We included 141 patients, among whom 68 were untreated. In the untreated versus TICI 3 patients, a median (interquartile range) of 53.7% (21.2%-87.7%) versus 5.3% (1.1%-14.6%) of penumbral tissue was consumed based on T
Conclusions: Among extended window endovascular thrombectomy patients, T