Usefulness of MRA-DWI mismatch in neuroendovascular therapy for acute cerebral infarction

被引:15
作者
Deguchi, I. [1 ]
Dembo, T. [1 ]
Fukuoka, T. [1 ]
Nagoya, H. [1 ]
Maruyama, H. [1 ]
Kato, Y. [1 ]
Oe, Y. [1 ]
Horiuchi, Y. [1 ]
Takeda, H. [1 ]
Tanahashi, N. [1 ]
机构
[1] Saitama Med Univ, Saitama Int Med Ctr, Dept Neurol & Cerebrovasc Med, Saitama 3501298, Japan
关键词
acute cerebral infarction; diffusion-weighted imaging-Alberta Stroke Program Early CT Score; MR angiography-diffusion-weighted imaging mismatch; neuroendovascular therapy; ACUTE ISCHEMIC-STROKE; TISSUE-PLASMINOGEN ACTIVATOR; HEMORRHAGIC TRANSFORMATION; INTERVENTIONAL MANAGEMENT; COMPUTED-TOMOGRAPHY; THROMBOLYSIS; DIFFUSION; TRIAL; RECANALIZATION; DESMOTEPLASE;
D O I
10.1111/j.1468-1331.2011.03444.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: This study evaluated the usefulness of MR angiography (MRA)diffusion-weighted imaging (DWI) mismatch in neuroendovascular therapy over 3 h after onset of acute cerebral infarction. Methods: The subjects were 14 cases ( age, 73 +/- 8.4 years) who had an anterior circulation deficit on DWI/ MRA on arrival and underwent neuroendovascular therapy over 3 h after onset. MRA-DWI mismatch ( MDM) (+) was defined as 'major artery lesion (+) and diffusion-weighted image-Alberta Stroke Program Early CT Score ( DWI-ASPECTS) 6'; MDM (-) was defined as 'major artery lesion (+) and DWI-ASPECTS < 6'. Results: Reperfusion was achieved in nine of 14 patients ( 64%) undergoing neuroendovascular therapy. Within the reperfusion group, in the five MDM (+) patients and the four MDM (-) patients, the outcome was a favorable clinical response in the MDM (+) group. The modified Rankin Scale ( mRS) scores after 90 days were 0-2 in 3 ( 60%) and 3-6 in 2 ( 40%) of the MDM (+) group patients and 0-2 in 0 ( 0%) and 3-6 in 4 ( 100%) of the MDM (-) group patients. In the MDM (+) group, a good outcome was achieved. However, the number of cases was small, so this was not a significant difference. Within the non-reperfusion group, in the three MDM (+) patients and the two MDM (-) patients, the mRS scores after 90 days were 0-2 in 1 ( 33%) and 3-6 in 2 ( 67%) of the MDM (+) group patients and 0-2 in 0 ( 0%) and 3-6 in 2 ( 100%) of the MDM (-) group patients. In both groups, the outcome was poor. Conclusions: With neuroendovascular therapy, a good outcome with reperfusion was achieved in the MDM (+) group compared to the MDM (-) group. This suggests that the presence or absence of MDM may be useful in determining prognosis after reperfusion.
引用
收藏
页码:114 / 120
页数:7
相关论文
共 20 条
[1]   Magnetic resonance imaging profiles predict clinical response to early reperfusion: The diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study [J].
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. .
ANNALS OF NEUROLOGY, 2006, 60 (05) :508-517
[2]   Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging [J].
Barber, PA ;
Hill, MD ;
Eliasziw, M ;
Demchuk, AM ;
Pexman, JHW ;
Hudon, ME ;
Tomanek, A ;
Frayne, R ;
Buchan, AM .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2005, 76 (11) :1528-1533
[3]   Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy [J].
Barber, PA ;
Demchuk, AM ;
Zhang, JJ ;
Buchan, AM .
LANCET, 2000, 355 (9216) :1670-1674
[5]   The interventional management of stroke (IMS) II study [J].
Broderick, Joseph P. .
STROKE, 2007, 38 (07) :2127-2135
[6]   Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial [J].
Davis, Stephen M. ;
Donnan, Geoffrey A. ;
Parsons, Mark W. ;
Levi, Christopher ;
Butcher, Kenneth S. ;
Peeters, Andre ;
Barber, P. Alan ;
Bladin, Christopher ;
De Silva, Deidre A. ;
Byrnes, Graham ;
Chalk, Jonathan B. ;
Fink, John N. ;
Kimber, Thomas E. ;
Schultz, David ;
Hand, Peter J. ;
Frayne, Judith ;
Hankey, Graeme ;
Muir, Keith ;
Gerraty, Richard ;
Tress, Brian M. ;
Desmond, Patricia M. .
LANCET NEUROLOGY, 2008, 7 (04) :299-309
[7]  
Deguchi I, J STROKE CE IN PRESS
[8]   Significance of Clinical-Diffusion Mismatch in Hyperacute Cerebral Infarction [J].
Deguchi, Ichiro ;
Takeda, Hidetaka ;
Furuya, Daisuke ;
Hattori, Kimihiko ;
Dembo, Tomohisa ;
Nagoya, Harumitsu ;
Kato, Yuji ;
Fukuoka, Takuya ;
Maruyama, Hajime ;
Tanahashi, Norio .
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 2011, 20 (01) :62-67
[9]   Hemorrhagic transformation within 36 hours of a cerebral infarct - Relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort [J].
Fiorelli, M ;
Bastianello, S ;
von Kummer, R ;
del Zoppo, GJ ;
Larrue, V ;
Lesaffre, E ;
Ringleb, AP ;
Lorenzano, S ;
Manelfe, C ;
Bozzao, L .
STROKE, 1999, 30 (11) :2280-2284
[10]   Dose escalation of desmoteplase for acute ischemic stroke (DEDAS) - Evidence of safety and efficacy 3 to 9 hours after stroke onset [J].
Furlan, AJ ;
Eyding, D ;
Albers, GW ;
Al-Rawi, Y ;
Lees, KR ;
Rowley, HA ;
Sachara, C ;
Soehngen, M ;
Warach, S ;
Hacke, W .
STROKE, 2006, 37 (05) :1227-1231