TY - JOUR
T1 - Value of Computed Tomographic Perfusion-Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment
AU - Borst, Jordi
AU - Berkhemer, Olvert A.
AU - Roos, Yvo B. W. E. M.
AU - van Bavel, Ed
AU - van Zwam, Wim H.
AU - van Oostenbrugge, Robert J.
AU - van Walderveen, Marianne A. A.
AU - Lingsma, Hester F.
AU - van der Lugt, Aad
AU - Dippel, Diederik W. J.
AU - Yoo, Albert J.
AU - Marquering, Henk A.
AU - Majoie, Charles B. L. M.
AU - AUTHOR GROUP
AU - Fransen, Puck S. S.
AU - Beumer, Debbie
AU - van den Berg, Lucie A.
AU - Schonewille, Wouter J.
AU - Vos, Jan Albert
AU - Nederkoorn, Paul J.
AU - Wermer, Marieke J. H.
AU - Staals, Julie
AU - Hofmeijer, Jeannette
AU - van Oostayen, Jacques A.
AU - Lycklama à Nijeholt, Geert J.
AU - Boiten, Jelis
AU - Brouwer, Patrick A.
AU - Emmer, Bart J.
AU - de Bruijn, Sebastiaan F.
AU - van Dijk, Lukas C.
AU - Kappelle, L. Jaap
AU - Lo, Rob H.
AU - van Dijk, Ewoud J.
AU - de Vries, Joost
AU - de Kort, Paul L. M.
AU - van den Berg, Jan S. P.
AU - van Hasselt, Boudewijn A. A. M.
AU - Aerden, Leo A. M.
AU - Dallinga, René J.
AU - Visser, Marieke C.
AU - Bot, Joseph C. J.
AU - Vroomen, Patrick C.
AU - Eshghi, Omid
AU - Schreuder, Tobien H. C. M. L.
AU - Sprengers, Marieke E. S.
AU - Beenen, Ludo F. M.
AU - van den Berg, René
AU - Santos, Emilie
AU - Jansen, Ivo
AU - Lucas, Marit
AU - Barros, Renan Sales
PY - 2015
Y1 - 2015
N2 - The utility of computed tomographic perfusion (CTP)-based patient selection for intra-arterial treatment of acute ischemic stroke has not been proven in randomized trials and requires further study in a cohort that was not selected based on CTP. Our objective was to study the relationship between CTP-derived parameters and outcome and treatment effect in patients with acute ischemic stroke because of a proximal intracranial arterial occlusion. We included 175 patients who underwent CTP in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN). Association of CTP-derived parameters (ischemic-core volume, penumbra volume, and percentage ischemic core) with outcome was estimated with multivariable ordinal logistic regression as an adjusted odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale. Interaction between CTP-derived parameters and treatment effect was determined using multivariable ordinal logistic regression. Interaction with treatment effect was also tested for mismatch (core <70 mL; penumbra core >1.2; penumbra core >10 mL). The adjusted odds ratio for improved functional outcome for ischemic core, percentage ischemic core, and penumbra were 0.79 per 10 mL (95% confidence interval: 0.71-0.89; P <0.001), 0.82 per 10% (95% confidence interval: 0.66-0.90; P=0.002), and 0.97 per 10 mL (96% confidence interval: 0.92-1.01; P=0.15), respectively. No significant interaction between any of the CTP-derived parameters and treatment effect was observed. We observed no significant interaction between mismatch and treatment effect. CTP seems useful for predicting functional outcome, but cannot reliably identify patients who will not benefit from intra-arterial therapy
AB - The utility of computed tomographic perfusion (CTP)-based patient selection for intra-arterial treatment of acute ischemic stroke has not been proven in randomized trials and requires further study in a cohort that was not selected based on CTP. Our objective was to study the relationship between CTP-derived parameters and outcome and treatment effect in patients with acute ischemic stroke because of a proximal intracranial arterial occlusion. We included 175 patients who underwent CTP in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN). Association of CTP-derived parameters (ischemic-core volume, penumbra volume, and percentage ischemic core) with outcome was estimated with multivariable ordinal logistic regression as an adjusted odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale. Interaction between CTP-derived parameters and treatment effect was determined using multivariable ordinal logistic regression. Interaction with treatment effect was also tested for mismatch (core <70 mL; penumbra core >1.2; penumbra core >10 mL). The adjusted odds ratio for improved functional outcome for ischemic core, percentage ischemic core, and penumbra were 0.79 per 10 mL (95% confidence interval: 0.71-0.89; P <0.001), 0.82 per 10% (95% confidence interval: 0.66-0.90; P=0.002), and 0.97 per 10 mL (96% confidence interval: 0.92-1.01; P=0.15), respectively. No significant interaction between any of the CTP-derived parameters and treatment effect was observed. We observed no significant interaction between mismatch and treatment effect. CTP seems useful for predicting functional outcome, but cannot reliably identify patients who will not benefit from intra-arterial therapy
U2 - https://doi.org/10.1161/STROKEAHA.115.010564
DO - https://doi.org/10.1161/STROKEAHA.115.010564
M3 - Article
C2 - 26542698
SN - 0039-2499
VL - 46
SP - 3375
EP - 3382
JO - Stroke; a journal of cerebral circulation
JF - Stroke; a journal of cerebral circulation
IS - 12
ER -