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Title: Different mismatch concepts for MRI-guided thrombolysis in unknown onset stroke.
Austin Authors: Scheldeman, Lauranne;Wouters, Anke;Boutitie, Florent;Dupont, Patrick;Christensen, Soren;Cheng, Bastian;Ebinger, Martin;Endres, Matthias;Fiebach, Jochen B;Gerloff, Christian;Muir, Keith W;Nighoghossian, Norbert;Pedraza, Salvador;Simonsen, Claus Z;Thijs, Vincent;Thomalla, Götz;Lemmens, Robin
Affiliation: Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA- Lyon, Hospices Civils de Lyon, Lyon, France
Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany
Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Neurology, University Hospitals Leuven, Leuven, Belgium
Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium
Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium..
Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
Klinik und Hochschulambulanz für Neurologie, Charité- Universitätsmedizin Berlin, Berlin, Germany
German Center for Cardiovascular Research (DZHK), partner site Berlin
German Center for Neurodegenerative Diseases (DZNE), partner site Berlin..
Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France, Université Lyon 1, F-69100, Villeurbanne, France
Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven - University of Leuven, Leuven, Belgium..
GrayNumber Analytics, Lomma, Sweden..
Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomedica de Girona (IDIBGI), Parc Hospitalari Marti i Julia de Salt - Edifici M2, Girona, Spain..
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark..
Issue Date: 30-Mar-2020
Date: 2020-03-30
Publication information: Annals of neurology 2020; online first: 30 March
Abstract: To explore the prevalence of the perfusion-weighted imaging (PWI) - diffusion-weighted imaging (DWI) mismatch and response to intravenous thrombolysis in the WAKE-UP trial. We performed a prespecified post-hoc analysis of ischemic stroke patients screened for DWI - fluid-attenuated inversion recovery (FLAIR) mismatch in WAKE-UP who underwent PWI. We defined PWI-DWI mismatch as ischemic core volume < 70 ml, mismatch volume > 10 ml and mismatch ratio > 1.2. Primary efficacy endpoint was a modified Rankin Scale score of 0-1 at 90 days, adjusted for age and symptom severity. Of 1,362 magnetic resonance imaging (MRI) screened patients, 431 underwent PWI. Of these, 57 (13%) had a double mismatch, 151 (35%) only a DWI-FLAIR mismatch and 54 (13%) only a PWI-DWI mismatch. DWI-FLAIR mismatch was more prevalent than PWI-DWI mismatch (48%; 95% CI 43%-53% vs 26%; 95% CI 22%-30%, p < 0.0001). Screening for either one of the mismatch profiles resulted in a yield of 61% (95% CI 56%-65%). Prevalence of PWI-DWI mismatch was similar in patients with (27%) or without (24%) DWI-FLAIR mismatch (p = 0.52). In an exploratory analysis in the small subgroup of 208 randomized patients with PWI, PWI-DWI mismatch status did not modify the treatment response (p for interaction = 0.73). Evaluating both the DWI-FLAIR and PWI-DWI mismatch pattern in patients with unknown time of stroke onset will result in the highest yield of thrombolysis treatment. The treatment benefit of alteplase in patients with a DWI-FLAIR mismatch seems not merely driven by the presence of a PWI-DWI mismatch, although this analysis was underpowered. This article is protected by copyright. All rights reserved.
DOI: 10.1002/ana.25730
ORCID: 0000-0002-5263-3550
Journal: Annals of neurology
PubMed URL: 32227638
Type: Journal Article
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