This Article Full Text Full Text (PDF) All Versions of this Article: 39/8/2257    most recent STROKEAHA.107.511535v1 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 Olivot, J.-M. Articles by Albers, G. W. Search for Related Content PubMed PubMed Citation Articles by Olivot, J.-M. Articles by Albers, G. W. Related Collections CT and MRI Acute Cerebral Infarction Thrombolysis

(Stroke. 2008;39:2257.)
© 2008 American Heart Association, Inc.

Original Contributions

Relationships Between Infarct Growth, Clinical Outcome, and Early Recanalization in Diffusion and Perfusion Imaging for Understanding Stroke Evolution (DEFUSE)

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

From the Department of Neurology and Neurological Sciences and the Stanford Stroke Center (J.-M.O., M.M., S.K., M.G.L., G.W.A.), Stanford University Medical Center, Stanford, Calif; the Vesalius Research Center (V.N.T.), VIB, Leuven, Belgium; the Department of Neurology (V.N.T.), University Hospitals Leuven, Belgium; UMPC Stroke Institute and Department of Neurology (L.W.), University of Pittsburgh, Pa; the Division of Cerebrovascular Disorders (G.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass; and the Department of Radiology and the Stanford Stroke Center (R.B., M.P.M.), Stanford University Medical Center, Stanford, Calif.

Correspondence to Dr J.M. Olivot, Department of Neurology and Neurological Sciences and the Stanford Stroke Center, Stanford University Medical Center, 701 Welch Road, Suite 325, Palo Alto, CA 94304. E-mail jmolivot{at}stanford.edu

Background and Purpose— The purpose of this study was to determine the relationships between ischemic lesion growth, recanalization, and clinical response in stroke patients with and without a perfusion/diffusion mismatch.

Methods— DEFUSE is an open label multicenter study in which 74 consecutive acute stroke patients were treated with intravenous tPA 3 to 6 hours after stroke onset. Magnetic resonance imaging (MRI) scans were obtained before, 3 to 6 hours after, and 30 days after treatment. Lesion growth was defined as the difference between the final infarct volume (30 day FLAIR) and the baseline diffusion lesion. Baseline MRI profiles were used to categorize 44 patients into Mismatch versus Absence of Mismatch subgroups. Early recanalization was assessed in 28 patients with an initial vessel lesion on magnetic resonance angiography. Infarct growth was compared based on whether a favorable clinical response (FCR) occurred and whether early recanalization was achieved.

Results— In the Mismatch subgroup, FCR was associated with less infarct growth P=0.03 and early recanalization was predictive of both FCR (odds ratio: 22, P=0.047) and reduced infarct growth P=0.024. There was no significant relationship between recanalization, infarct growth, and clinical outcome in the Absence of Mismatch subgroup. A threshold of <7 cc of growth had the highest sensitivity and specificity for predicting a FCR in Mismatch patients (odds ratio: 65, P=0.015, sensitivity 82%, specificity 75%).

Conclusion— In contrast to Absence of Mismatch patients, significant associations between recanalization, reduced infarct growth, and favorable clinical response were documented in patients with a perfusion/diffusion mismatch who were treated with tPA within 3 to 6 hours after stroke onset. These findings support the Mismatch hypothesis but require validation in a larger study.

Key Words: acute cerebral infarction • magnetic resonance imaging • diffusion-weighted imaging • thrombolysis

This article has been cited by other articles:

				J.-M. Olivot, M. Mlynash, V. N. Thijs, A. Purushotham, S. Kemp, M. G. Lansberg, L. Wechsler, G. E. Gold, R. Bammer, M. P. Marks, et al. Geography, Structure, and Evolution of Diffusion and Perfusion Lesions in Diffusion and Perfusion Imaging Evaluation For Understanding Stroke Evolution (DEFUSE) Stroke, October 1, 2009; 40(10): 3245 - 3251. [Abstract] [Full Text] [PDF]

				J.-M. Olivot, M. Mlynash, V. N. Thijs, A. Purushotham, S. Kemp, M. G. Lansberg, L. Wechsler, R. Bammer, M. P. Marks, and G. W. Albers Relationships Between Cerebral Perfusion and Reversibility of Acute Diffusion Lesions in DEFUSE: Insights from RADAR Stroke, May 1, 2009; 40(5): 1692 - 1697. [Abstract] [Full Text] [PDF]