Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22923
Title: Different mismatch concepts for MRI-guided thrombolysis in unknown onset stroke.
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 Neurology, Austin Health, Heidelberg, Victoria, Australia
Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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..
Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany..
Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France, Université Lyon 1, F-69100, Villeurbanne, France
CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, 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..
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany..
Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany..
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany..
Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA- Lyon, Hospices Civils de Lyon, Lyon, France..
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..
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany..
Issue Date: 30-Mar-2020
EDate: 2020-03-30
Citation: 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.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22923
DOI: 10.1002/ana.25730
ORCID: 0000-0002-5263-3550
0000-0001-6520-3720
0000-0002-6614-8417
PubMed URL: 32227638
Type: Journal Article
Appears in Collections:Journal articles

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