This Article Full Text Full Text (PDF) All Versions of this Article: 39/9/2491    most recent STROKEAHA.107.508572v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lansberg, M. G. Articles by Albers, G. W. Search for Related Content PubMed PubMed Citation Articles by Lansberg, M. G. Articles by Albers, G. W. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Stroke Related Collections CT and MRI Acute Cerebral Infarction Emergency treatment of Stroke Computerized tomography and Magnetic Resonance Imaging Thrombolysis

(Stroke. 2008;39:2491.)
© 2008 American Heart Association, Inc.

Original Contributions

The MRA-DWI Mismatch Identifies Patients With Stroke Who Are Likely to Benefit From Reperfusion

Maarten G. Lansberg, MD, PhD; Vincent N. Thijs, MD, PhD; Roland Bammer, PhD; Jean-Marc Olivot, MD; Michael P. Marks, MD; Lawrence R. Wechsler, MD; Stephanie Kemp, BS Gregory W. Albers, MD

From the Stanford Stroke Center (M.G.L., R.B., J.M.O., M.M., S.K., G.W.A.), Stanford University Medical Center, Palo Alto, Calif; the Department of Neurology (V.N.T.), University Hospitals of Leuven, Leuven, Belgium; and the Stroke Institute (L.R.W.), University of Pittsburgh Medical Center, Pittsburgh, Pa.

Correspondence to Maarten G. Lansberg, MD, PhD, Stanford Stroke Center, 701 Welch Road, Suite B325, Palo Alto, CA 94304-9705. E-mail lansberg{at}stanford.edu

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.

Key Words: MRI • stroke • thrombolysis

This article has been cited by other articles:

				J.-M. Olivot, M. Mlynash, V. N. Thijs, S. Kemp, M. G. Lansberg, L. Wechsler, R. Bammer, M. P. Marks, and G. W. Albers Optimal Tmax Threshold for Predicting Penumbral Tissue in Acute Stroke Stroke, February 1, 2009; 40(2): 469 - 475. [Abstract] [Full Text] [PDF]