Patients with Acute Stroke Treated with Intravenous tPA 3-6 Hours after Stroke Onset: Correlations between MR Angiography Findings and Perfusion- and Diffusion-weighted Imaging in the DEFUSE Study

被引:48
作者
Marks, Michael P. [1 ,2 ]
Olivot, Jean-Marc [3 ]
Kemp, Stephanie [3 ]
Lansberg, Maarten G. [3 ]
Bammer, Roland [1 ]
Wechsler, Lawrence R. [4 ]
Albers, Gregory W. [3 ]
Thijs, Vincent [5 ]
机构
[1] Stanford Univ, Med Ctr, Dept Radiol, Stanford, CA 94305 USA
[2] Stanford Univ, Med Ctr, Dept Neurosurg, Stanford, CA 94305 USA
[3] Stanford Univ, Med Ctr, Dept Neurol, Stanford, CA 94305 USA
[4] Univ Pittsburgh, Dept Neurol, Pittsburgh, PA 15260 USA
[5] Katholieke Univ Leuven Hosp, Dept Neurol, Louvain, Belgium
基金
美国国家卫生研究院;
关键词
D O I
10.1148/radiol.2492071751
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: To study magnetic resonance (MR) angiography findings in patients with acute stroke treated with intravenous tissue plasminogen activator (tPA) in relationship to perfusion- and diffusion-weighted imaging changes and clinical outcome. Materials and Methods: Patients treated with intravenous tPA 3-6 hours after stroke onset ( with informed consent) were evaluated in a HIPAA-compliant multicenter prospective study approved by all institutional review boards. MR imaging and MR angiography studies were performed before and 3-6 hours after treatment. MR angiography studies that were technically adequate at both time points were evaluated for occlusion, decreased flow, any early recanalization, and degree of recanalization. These results were compared with favorable clinical response ( an improvement in National Institutes of Health Stroke Scale score of >= 8 points at 30 days or a modified Rankin scale score of 0 or 1 at 30 days) in patients with and those without mismatch between perfusion- and diffusion-weighted imaging at baseline. Results: Seventy-four patients were enrolled in the initial investigation; pre- and posttreatment MR angiography studies were both technically adequate in 62 patients. MR angiography demonstrated occlusion or decreased flow in 46 patients. Patients with isolated middle cerebral artery (MCA) occlusion and early recanalization at MR angiography had higher rates of favorable clinical response than those with tandem internal carotid artery-MCA occlusion and early recanalization (P = .05). Any early recanalization was not associated with favorable clinical response, but degree of recanalization did correlate with favorable clinical response (P = .048). Favorable clinical response was more frequently seen in patients with mismatch between perfusion- and diffusion-weighted imaging findings at baseline who experienced early recanalization than in those who did not have early recanalization (odds ratio = 6.2; 95% confidence interval: 1.3, 30.2; P = .021). No relationship between early recanalization and favorable clinical response was seen in patients without mismatch. Conclusion: Early recanalization seen at MR angiography before and after treatment coupled with diffusion- and perfusion-weighted imaging data may predict clinical outcome in patients with stroke treated with tPA 3-6 hours after symptom onset. (c) RSNA, 2008
引用
收藏
页码:614 / 623
页数:10
相关论文
共 15 条
  • [1] Magnetic resonance imaging profiles predict clinical response to early reperfusion: The diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study
    Albers, Gregory W.
    Thijs, Vincent N.
    Wechsle, Lawrence
    Kemp, Stephanie
    Schlaug, Gottfried
    Skalabrin, Elaine
    Bammer, Roland
    Kakuda, Wataru
    Lansberg, Maarten G.
    Shuaib, Ashfaq
    Coplin, William
    Hamilton, Scott
    Moseley, Michael
    Marks, Michael P.
    [J]. ANNALS OF NEUROLOGY, 2006, 60 (05) : 508 - 517
  • [2] Absent middle cerebral artery flow predicts the presence and evolution of the ischemic penumbra
    Barber, PA
    Davis, SM
    Darby, DG
    Desmond, PM
    Gerraty, RP
    Yang, Q
    Jolley, D
    Donnan, GA
    Tress, BM
    [J]. NEUROLOGY, 1999, 52 (06) : 1125 - 1132
  • [3] Refining the perfusion-diffusion mismatch hypothesis
    Butcher, KS
    Parsons, M
    MacGregor, L
    Barber, PA
    Chalk, J
    Bladin, C
    Levi, C
    Kimber, T
    Schultz, D
    Fink, J
    Tress, B
    Donnan, G
    Davis, S
    [J]. STROKE, 2005, 36 (06) : 1153 - 1159
  • [4] Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset - The ATLANTIS study: A randomized controlled trial
    Clark, WM
    Wissman, S
    Albers, GW
    Jhamandas, JH
    Madden, KP
    Hamilton, S
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 282 (21): : 2019 - 2026
  • [5] Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II)
    Hacke, W
    Kaste, M
    Fieschi, C
    von Kummer, R
    Davalos, A
    Meier, D
    Larrue, V
    Bluhmki, E
    Davis, S
    Donnan, G
    Schneider, D
    Diez-Tejedor, E
    Trouillas, P
    [J]. LANCET, 1998, 352 (9136) : 1245 - 1251
  • [6] HACKE W, 1995, JAMA-J AM MED ASSOC, V274, P1017, DOI 10.1001/jama.274.13.1017
  • [7] Early recanalization after intravenous administration of recombinant tissue plasminogen activator as assessed by pre- and post-thrombolytic angiography in acute ischemic stroke patients
    Lee, Kyung-Yul
    Han, Sang Won
    Kim, Seo Hyun
    Nam, Hyo Seok
    Ahn, Sung Whan
    Kim, Dong Joon
    Seo, Sang Hyun
    Kim, Dong Ik
    Heo, Ji Hoe
    [J]. STROKE, 2007, 38 (01) : 192 - 193
  • [8] TISSUE-PLASMINOGEN ACTIVATOR FOR ACUTE ISCHEMIC STROKE
    MARLER, JR
    BROTT, T
    BRODERICK, J
    KOTHARI, R
    ODONOGHUE, M
    BARSAN, W
    TOMSICK, T
    SPILKER, J
    MILLER, R
    SAUERBECK, L
    JARRELL, J
    KELLY, J
    PERKINS, T
    MCDONALD, T
    RORICK, M
    HICKEY, C
    ARMITAGE, J
    PERRY, C
    THALINGER, K
    RHUDE, R
    SCHILL, J
    BECKER, PS
    HEATH, RS
    ADAMS, D
    REED, R
    KLEI, M
    HUGHES, S
    ANTHONY, J
    BAUDENDISTEL, D
    ZADICOFF, C
    RYMER, M
    BETTINGER, I
    LAUBINGER, P
    SCHMERLER, M
    MEIROSE, G
    LYDEN, P
    RAPP, K
    BABCOCK, T
    DAUM, P
    PERSONA, D
    BRODY, M
    JACKSON, C
    LEWIS, S
    LISS, J
    MAHDAVI, Z
    ROTHROCK, J
    TOM, T
    ZWEIFLER, R
    DUNFORD, J
    ZIVIN, J
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (24) : 1581 - 1587
  • [9] Diffusion- and perfusion-weighted MRI response to thrombolysis in stroke
    Parsons, MW
    Barber, PA
    Chalk, J
    Darby, DG
    Rose, S
    Desmond, PM
    Gerraty, RP
    Tress, BM
    Wright, PM
    Donnan, GA
    Davis, SM
    [J]. ANNALS OF NEUROLOGY, 2002, 51 (01) : 28 - 37
  • [10] The impact of recanalization on ischemic stroke outcome - A meta-analysis
    Rha, Joung-Ho
    Saver, Jeffrey L.
    [J]. STROKE, 2007, 38 (03) : 967 - 973