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Title: Different Mismatch Concepts for Magnetic Resonance Imaging-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 N ;Thomalla, Götz;Lemmens, Robin
Affiliation: Department of Stroke Medicine, Claude Bernard University Lyon 1, CREATIS National Center for Scientific Research Mixed Unit of Research 5220-National Institute of Health and Medical Research U1206, National Institute of Applied Sciences of Lyon, Lyon Civil Hospices, Lyon, France
German Center for Neurodegenerative Diseases, Berlin, Germany
Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Neurology Clinic, Medical Park Berlin Humboldtmühle, Berlin, Germany
Centre national de la recherche scientifique, unité mixte de recherche 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium
Center for Brain & Disease Research, Laboratory of Neurobiology, Flanders Institute for Biotechnology, Leuven, Belgium..
Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France
Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
Department of Neurology, University Hospitals Leuven, Leuven, Belgium
German Center for Cardiovascular Research, Berlin, Germany
The Florey Institute of Neuroscience and Mental Health
Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven-University of Leuven, Leuven, Belgium..
GrayNumber Analytics, Lomma, Sweden..
Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, United Kingdom..
Department of Radiology, Institute of Diagnostic Imaging, Dr Josep Trueta Hospital, Girona Institute of Biomedical Research, Marti and Julia de Salt Hospital Park - Building M2, Girona, Spain..
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark..
Issue Date: Jun-2020 2020-04-20
Publication information: Annals of Neurology 2020; 87(6): 931-938
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 < 70ml, mismatch volume > 10ml, and mismatch ratio > 1.2. Primary efficacy end point was a modified Rankin Scale score of 0-1 at 90 days, adjusted for age and symptom severity. Of 1,362 magnetic resonance imaging-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% confidence interval [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 patterns 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 to be driven not merely by the presence of a PWI-DWI mismatch, although this analysis was underpowered. ANN NEUROL 2020;87:931-938.
DOI: 10.1002/ana.25730
ORCID: 0000-0002-5263-3550
PubMed URL: 32227638
Type: Journal Article
Appears in Collections:Journal articles

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