Published Online
on July 17, 2008

A more recent version of this article appeared on September 1, 2008

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Submitted on October 26, 2007
Revised on January 22, 2008
Accepted on January 29, 2008

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; and 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.

^* To whom correspondence should be addressed. 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

Related Article:

MRA/DWI Mismatch: A Novel Concept or Something One Could Get Easier and Cheaper?

Peter D. Schellinger and Martin Köhrmann
Stroke 2008 39: 2423-2424. [Extract] [Full Text] [PDF]

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