MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): A prospective cohort study

Maarten G. Lansberg, Matus Straka, Stephanie Kemp, Michael Mlynash, Lawrence R. Wechsler, Tudor G. Jovin, Michael J. Wilder, Helmi L. Lutsep, Todd J. Czartoski, Richard A. Bernstein, Cherylee W J Chang, Steven Warach, Franz Fazekas, Manabu Inoue, Aaryani Tipirneni, Scott A. Hamilton, Greg Zaharchuk, Michael P. Marks, Roland Bammer, Gregory W. Albers

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Abstract

Background: Whether endovascular stroke treatment improves clinical outcomes is unclear because of the paucity of data from randomised placebo-controlled trials. We aimed to establish whether MRI can be used to identify patients who are most likely to benefit from endovascular reperfusion. Methods: In this prospective cohort study we consecutively enrolled patients scheduled to have endovascular treatment within 12 h of onset of stroke at eight centres in the USA and one in Austria. Aided by an automated image analysis computer program, investigators interpreted a baseline MRI scan taken before treatment to establish whether the patient had an MRI profile (target mismatch) that suggested salvageable tissue was present. Reperfusion was assessed on an early follow-up MRI scan (within 12 h of the revascularisation procedure) and defined as a more than 50% reduction in the volume of the lesion from baseline on perfusion-weighted MRI. The primary outcome was favourable clinical response, defined as an improvement of 8 or more on the National Institutes of Health Stroke Scale between baseline and day 30 or a score of 0-1 at day 30. The secondary clinical endpoint was good functional outcome, defined as a modified Rankin scale score of 2 or less at day 90. Analyses were adjusted for imbalances in baseline predictors of outcome. Investigators assessing outcomes were masked to baseline data. Findings: 138 patients were enrolled. 110 patients had catheter angiography and of these 104 had an MRI profile and 99 could be assessed for reperfusion. 46 of 78 (59%) patients with target mismatch and 12 of 21 (57%) patients without target mismatch had reperfusion after endovascular treatment. The adjusted odds ratio (OR) for favourable clinical response associated with reperfusion was 8·8 (95% CI 2·7-29·0) in the target mismatch group and 0·2 (0·0-1·6) in the no target mismatch group (p=0·003 for difference between ORs). Reperfusion was associated with increased good functional outcome at 90 days (OR 4·0, 95% CI 1·3-12·2) in the target mismatch group, but not in the no target mismatch group (1·9, 0·2-18·7). Interpretation: Target mismatch patients who had early reperfusion after endovascular stroke treatment had more favourable clinical outcomes. No association between reperfusion and favourable outcomes was present in patients without target mismatch. Our data suggest that a randomised controlled trial of endovascular treatment for patients with the target mismatch profile is warranted. Funding: National Institute for Neurological Disorders and Stroke.

Original languageEnglish (US)
Pages (from-to)860-867
Number of pages8
JournalThe Lancet Neurology
Volume11
Issue number10
DOIs
StatePublished - Oct 2012

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Reperfusion
Cohort Studies
Stroke
Prospective Studies
Therapeutics
Randomized Controlled Trials
Odds Ratio
Research Personnel
Magnetic Resonance Imaging
National Institute of Neurological Disorders and Stroke
Magnetic Resonance Angiography
Austria
National Institutes of Health (U.S.)
Angiography
Software
Catheters
Placebos

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Lansberg, M. G., Straka, M., Kemp, S., Mlynash, M., Wechsler, L. R., Jovin, T. G., ... Albers, G. W. (2012). MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): A prospective cohort study. The Lancet Neurology, 11(10), 860-867. https://doi.org/10.1016/S1474-4422(12)70203-X

MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2) : A prospective cohort study. / Lansberg, Maarten G.; Straka, Matus; Kemp, Stephanie; Mlynash, Michael; Wechsler, Lawrence R.; Jovin, Tudor G.; Wilder, Michael J.; Lutsep, Helmi L.; Czartoski, Todd J.; Bernstein, Richard A.; Chang, Cherylee W J; Warach, Steven; Fazekas, Franz; Inoue, Manabu; Tipirneni, Aaryani; Hamilton, Scott A.; Zaharchuk, Greg; Marks, Michael P.; Bammer, Roland; Albers, Gregory W.

In: The Lancet Neurology, Vol. 11, No. 10, 10.2012, p. 860-867.

Research output: Contribution to journalArticle

Lansberg, MG, Straka, M, Kemp, S, Mlynash, M, Wechsler, LR, Jovin, TG, Wilder, MJ, Lutsep, HL, Czartoski, TJ, Bernstein, RA, Chang, CWJ, Warach, S, Fazekas, F, Inoue, M, Tipirneni, A, Hamilton, SA, Zaharchuk, G, Marks, MP, Bammer, R & Albers, GW 2012, 'MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): A prospective cohort study', The Lancet Neurology, vol. 11, no. 10, pp. 860-867. https://doi.org/10.1016/S1474-4422(12)70203-X
Lansberg, Maarten G. ; Straka, Matus ; Kemp, Stephanie ; Mlynash, Michael ; Wechsler, Lawrence R. ; Jovin, Tudor G. ; Wilder, Michael J. ; Lutsep, Helmi L. ; Czartoski, Todd J. ; Bernstein, Richard A. ; Chang, Cherylee W J ; Warach, Steven ; Fazekas, Franz ; Inoue, Manabu ; Tipirneni, Aaryani ; Hamilton, Scott A. ; Zaharchuk, Greg ; Marks, Michael P. ; Bammer, Roland ; Albers, Gregory W. / MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2) : A prospective cohort study. In: The Lancet Neurology. 2012 ; Vol. 11, No. 10. pp. 860-867.
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T1 - MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2)

T2 - A prospective cohort study

AU - Lansberg, Maarten G.

AU - Straka, Matus

AU - Kemp, Stephanie

AU - Mlynash, Michael

AU - Wechsler, Lawrence R.

AU - Jovin, Tudor G.

AU - Wilder, Michael J.

AU - Lutsep, Helmi L.

AU - Czartoski, Todd J.

AU - Bernstein, Richard A.

AU - Chang, Cherylee W J

AU - Warach, Steven

AU - Fazekas, Franz

AU - Inoue, Manabu

AU - Tipirneni, Aaryani

AU - Hamilton, Scott A.

AU - Zaharchuk, Greg

AU - Marks, Michael P.

AU - Bammer, Roland

AU - Albers, Gregory W.

PY - 2012/10

Y1 - 2012/10

N2 - Background: Whether endovascular stroke treatment improves clinical outcomes is unclear because of the paucity of data from randomised placebo-controlled trials. We aimed to establish whether MRI can be used to identify patients who are most likely to benefit from endovascular reperfusion. Methods: In this prospective cohort study we consecutively enrolled patients scheduled to have endovascular treatment within 12 h of onset of stroke at eight centres in the USA and one in Austria. Aided by an automated image analysis computer program, investigators interpreted a baseline MRI scan taken before treatment to establish whether the patient had an MRI profile (target mismatch) that suggested salvageable tissue was present. Reperfusion was assessed on an early follow-up MRI scan (within 12 h of the revascularisation procedure) and defined as a more than 50% reduction in the volume of the lesion from baseline on perfusion-weighted MRI. The primary outcome was favourable clinical response, defined as an improvement of 8 or more on the National Institutes of Health Stroke Scale between baseline and day 30 or a score of 0-1 at day 30. The secondary clinical endpoint was good functional outcome, defined as a modified Rankin scale score of 2 or less at day 90. Analyses were adjusted for imbalances in baseline predictors of outcome. Investigators assessing outcomes were masked to baseline data. Findings: 138 patients were enrolled. 110 patients had catheter angiography and of these 104 had an MRI profile and 99 could be assessed for reperfusion. 46 of 78 (59%) patients with target mismatch and 12 of 21 (57%) patients without target mismatch had reperfusion after endovascular treatment. The adjusted odds ratio (OR) for favourable clinical response associated with reperfusion was 8·8 (95% CI 2·7-29·0) in the target mismatch group and 0·2 (0·0-1·6) in the no target mismatch group (p=0·003 for difference between ORs). Reperfusion was associated with increased good functional outcome at 90 days (OR 4·0, 95% CI 1·3-12·2) in the target mismatch group, but not in the no target mismatch group (1·9, 0·2-18·7). Interpretation: Target mismatch patients who had early reperfusion after endovascular stroke treatment had more favourable clinical outcomes. No association between reperfusion and favourable outcomes was present in patients without target mismatch. Our data suggest that a randomised controlled trial of endovascular treatment for patients with the target mismatch profile is warranted. Funding: National Institute for Neurological Disorders and Stroke.

AB - Background: Whether endovascular stroke treatment improves clinical outcomes is unclear because of the paucity of data from randomised placebo-controlled trials. We aimed to establish whether MRI can be used to identify patients who are most likely to benefit from endovascular reperfusion. Methods: In this prospective cohort study we consecutively enrolled patients scheduled to have endovascular treatment within 12 h of onset of stroke at eight centres in the USA and one in Austria. Aided by an automated image analysis computer program, investigators interpreted a baseline MRI scan taken before treatment to establish whether the patient had an MRI profile (target mismatch) that suggested salvageable tissue was present. Reperfusion was assessed on an early follow-up MRI scan (within 12 h of the revascularisation procedure) and defined as a more than 50% reduction in the volume of the lesion from baseline on perfusion-weighted MRI. The primary outcome was favourable clinical response, defined as an improvement of 8 or more on the National Institutes of Health Stroke Scale between baseline and day 30 or a score of 0-1 at day 30. The secondary clinical endpoint was good functional outcome, defined as a modified Rankin scale score of 2 or less at day 90. Analyses were adjusted for imbalances in baseline predictors of outcome. Investigators assessing outcomes were masked to baseline data. Findings: 138 patients were enrolled. 110 patients had catheter angiography and of these 104 had an MRI profile and 99 could be assessed for reperfusion. 46 of 78 (59%) patients with target mismatch and 12 of 21 (57%) patients without target mismatch had reperfusion after endovascular treatment. The adjusted odds ratio (OR) for favourable clinical response associated with reperfusion was 8·8 (95% CI 2·7-29·0) in the target mismatch group and 0·2 (0·0-1·6) in the no target mismatch group (p=0·003 for difference between ORs). Reperfusion was associated with increased good functional outcome at 90 days (OR 4·0, 95% CI 1·3-12·2) in the target mismatch group, but not in the no target mismatch group (1·9, 0·2-18·7). Interpretation: Target mismatch patients who had early reperfusion after endovascular stroke treatment had more favourable clinical outcomes. No association between reperfusion and favourable outcomes was present in patients without target mismatch. Our data suggest that a randomised controlled trial of endovascular treatment for patients with the target mismatch profile is warranted. Funding: National Institute for Neurological Disorders and Stroke.

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