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Title: The MRA-DWI mismatch identifies patients with stroke who are likely to benefit from reperfusion
Authors: Lansberg, Maarten G
Thijs, Vincent ×
Bammer, Roland
Olivot, Jean-Marc
Marks, Michael P
Wechsler, Lawrence R
Kemp, Stephanie
Albers, Gregory W #
Issue Date: Sep-2008
Publisher: Lippincott williams & wilkins
Series Title: Stroke vol:39 issue:9 pages:2491-2496
Abstract: BACKGROUND AND PURPOSE: The aim of this exploratory analysis was to evaluate if a combination of MR angiography (MRA) and diffusion-weighted imaging (DWI) selection criteria can be used to identify patients with acute stroke who are likely to benefit from early reperfusion. METHODS: Data from DEFUSE, a study of 74 patients with stroke who received intravenous tissue plasminogen activator in the 3- to 6-hour time window and underwent MRIs before and approximately 4 hours after treatment were analyzed. The MRA-DWI mismatch model was defined as (1) a DWI lesion volume less than 25 mL in patients with a proximal vessel occlusion; or (2) a DWI lesion volume less than 15 mL in patients with proximal vessel stenosis or an abnormal finding of a distal vessel. Favorable clinical response was defined as an improvement on the National Institutes of Health Stroke Scale score of at least 8 points between baseline and 30 days or a National Institutes of Health Stroke Scale score </=1 at 30 days. RESULTS: Twenty-seven of 62 patients (44%) had an MRA-DWI mismatch. There was a differential response to early reperfusion based on MRA-DWI mismatch status. Reperfusion was associated with an increased rate of a favorable clinical response in patients with an MRA-DWI mismatch (OR, 12.5; 95% CI, 1.8 to 83.9) and a lower rate in patients without mismatch (OR, 0.2; 95% CI, 0.0 to 0.8). CONCLUSIONS: The MRA-DWI mismatch model appears to identify patients with stroke who are likely to benefit from reperfusion therapy administered in the 3- to 6-hour time window after symptom onset. The criteria established for the MRA-DWI mismatch model in this study require validation in an independent cohort.
URI: 
ISSN: 0039-2499
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Research Group Experimental Neurology
Laboratory for Neurobiology (Vesalius Research Center)
× corresponding author
# (joint) last author

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