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Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment.
- Source :
-
Stroke [Stroke] 2015 Sep; Vol. 46 (9), pp. 2510-6. Date of Electronic Publication: 2015 Aug 06. - Publication Year :
- 2015
-
Abstract
- Background and Purpose: Lesion volume on diffusion-weighted magnetic resonance imaging (DWI) before acute stroke therapy is a predictor of outcome. Therefore, patients with large volumes are often excluded from therapy. The aim of this study was to analyze the impact of endovascular treatment in patients with large DWI lesion volumes (>70 mL).<br />Methods: Three hundred seventy-two patients with middle cerebral or internal carotid artery occlusions examined with magnetic resonance imaging before treatment since 2004 were included. Baseline data and 3 months outcome were recorded prospectively. DWI lesion volumes were measured semiautomatically.<br />Results: One hundred five patients had lesions >70 mL. Overall, the volume of DWI lesions was an independent predictor of unfavorable outcome, survival, and symptomatic intracerebral hemorrhage (P<0.001 each). In patients with DWI lesions >70 mL, 11 of 31 (35.5%) reached favorable outcome (modified Rankin scale score, 0-2) after thrombolysis in cerebral infarction 2b-3 reperfusion in contrast to 3 of 35 (8.6%) after thrombolysis in cerebral infarction 0-2a reperfusion (P=0.014). Reperfusion success, patient age, and DWI lesion volume were independent predictors of outcome in patients with DWI lesions >70 mL. Thirteen of 66 (19.7%) patients with lesions >70 mL had symptomatic intracerebral hemorrhage with a trend for reduced risk with avoidance of thrombolytic agents.<br />Conclusions: There was a growing risk for poor outcome and symptomatic intracerebral hemorrhage with increasing pretreatment DWI lesion volumes. Nevertheless, favorable outcome was achieved in every third patient with DWI lesions >70 mL after successful endovascular reperfusion, whereas after poor or failed reperfusion, outcome was favorable in only every 12th patient. Therefore, endovascular treatment might be considered in patients with large DWI lesions, especially in younger patients.<br /> (© 2015 American Heart Association, Inc.)
- Subjects :
- Age Factors
Aged
Aged, 80 and over
Arterial Occlusive Diseases drug therapy
Arterial Occlusive Diseases pathology
Carotid Artery, Internal pathology
Cerebral Hemorrhage etiology
Cerebral Infarction complications
Diffusion Magnetic Resonance Imaging
Female
Humans
Male
Middle Aged
Middle Cerebral Artery pathology
Severity of Illness Index
Cerebral Infarction drug therapy
Cerebral Infarction pathology
Cerebrovascular Circulation drug effects
Outcome Assessment, Health Care
Registries
Thrombolytic Therapy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4628
- Volume :
- 46
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Stroke
- Publication Type :
- Academic Journal
- Accession number :
- 26251252
- Full Text :
- https://doi.org/10.1161/STROKEAHA.115.010250