Penumbral imaging and functional outcome ...
Type de document :
Article dans une revue scientifique: Article original
PMID :
URL permanente :
Titre :
Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data
Auteur(s) :
Campbell, Bruce C. V. [Auteur]
Majoie, Charles B. L. M. [Auteur]
Albers, Gregory W. [Auteur]
Menon, Bijoy K. [Auteur]
Yassi, Nawaf [Auteur]
Sharma, Gagan [Auteur]
Van Zwam, Wim H. [Auteur]
Van Oostenbrugge, Robert J. [Auteur]
Demchuk, Andrew M. [Auteur]
Guillemin, Francis [Auteur]
White, Philip M. [Auteur]
Davalos, Antoni [Auteur]
Van Der Lugt, Aad [Auteur]
Butcher, Kenneth S. [Auteur]
Cherifi, Aboubaker [Auteur]
Marquering, Henk A. [Auteur]
Cloud, Geoffrey [Auteur]
Macho Fernandez, Juan M. [Auteur]
Madigan, Jeremy [Auteur]
Oppenheim, Catherine [Auteur]
Donnan, Geoffrey A. [Auteur]
Roos, Yvo B. [Auteur]
Shankar, Jai [Auteur]
Lingsma, Hester F. [Auteur]
Bonafe, Alain [Auteur]
Raoult, Helene [Auteur]
Hernandez-Perez, Maria [Auteur]
Bharatha, Aditya [Auteur]
Jahan, Reza [Auteur]
Jansen, Olav [Auteur]
Richard, Sébastien [Auteur]
Levy, Elad I. [Auteur]
Berkhemer, Olvert A. [Auteur]
Soudant, Marc [Auteur]
Aja, Lucia [Auteur]
Davis, Stephen M. [Auteur]
Krings, Timo [Auteur]
Tisserand, Marie [Auteur]
San Roman, Luis [Auteur]
Tomasello, Alejandro [Auteur]
Beumer, Debbie [Auteur]
Brown, Scott [Auteur]
Liebeskind, David S. [Auteur]
Bracard, Serge [Auteur]
Muir, Keith W. [Auteur]
Dippel, Diederik W J. [Auteur]
Goyal, Mayank [Auteur]
Saver, Jeffrey L. [Auteur]
Jovin, Tudor G. [Auteur]
Hill, Michael D. [Auteur]
Mitchell, Peter J. [Auteur]
Majoie, Charles B. L. M. [Auteur]
Albers, Gregory W. [Auteur]
Menon, Bijoy K. [Auteur]
Yassi, Nawaf [Auteur]
Sharma, Gagan [Auteur]
Van Zwam, Wim H. [Auteur]
Van Oostenbrugge, Robert J. [Auteur]
Demchuk, Andrew M. [Auteur]
Guillemin, Francis [Auteur]
White, Philip M. [Auteur]
Davalos, Antoni [Auteur]
Van Der Lugt, Aad [Auteur]
Butcher, Kenneth S. [Auteur]
Cherifi, Aboubaker [Auteur]
Marquering, Henk A. [Auteur]
Cloud, Geoffrey [Auteur]
Macho Fernandez, Juan M. [Auteur]
Madigan, Jeremy [Auteur]
Oppenheim, Catherine [Auteur]
Donnan, Geoffrey A. [Auteur]
Roos, Yvo B. [Auteur]
Shankar, Jai [Auteur]
Lingsma, Hester F. [Auteur]
Bonafe, Alain [Auteur]
Raoult, Helene [Auteur]
Hernandez-Perez, Maria [Auteur]
Bharatha, Aditya [Auteur]
Jahan, Reza [Auteur]
Jansen, Olav [Auteur]
Richard, Sébastien [Auteur]
Levy, Elad I. [Auteur]
Berkhemer, Olvert A. [Auteur]
Soudant, Marc [Auteur]
Aja, Lucia [Auteur]
Davis, Stephen M. [Auteur]
Krings, Timo [Auteur]
Tisserand, Marie [Auteur]
San Roman, Luis [Auteur]
Tomasello, Alejandro [Auteur]
Beumer, Debbie [Auteur]
Brown, Scott [Auteur]
Liebeskind, David S. [Auteur]
Bracard, Serge [Auteur]
Muir, Keith W. [Auteur]
Dippel, Diederik W J. [Auteur]
Goyal, Mayank [Auteur]
Saver, Jeffrey L. [Auteur]
Jovin, Tudor G. [Auteur]
Hill, Michael D. [Auteur]
Mitchell, Peter J. [Auteur]
Titre de la revue :
The Lancet. Neurology
Nom court de la revue :
Lancet Neurol
Date de publication :
2018-11-06
ISSN :
1474-4465
Discipline(s) HAL :
Sciences du Vivant [q-bio]
Résumé en anglais : [en]
BACKGROUND: CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and ...
Lire la suite >BACKGROUND: CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome. METHODS: In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1, 2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 μm2 RESULTS: We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) patients and diffusion MRI for 309 (18%) patients. Functional independence was worse in patients who had CTP versus those who had diffusion MRI, after adjustment for ischaemic core volume (odds ratio [OR] 0·47 [95% CI 0·30-0·72], p=0·0007), so the imaging modalities were not pooled. Increasing ischaemic core volume was associated with reduced likelihood of functional independence (CTP OR 0·77 [0·69-0·86] per 10 mL, pinteractioninteraction CONCLUSIONS: Estimated ischaemic core volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic core volume with age and expected imaging-to-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions. BACKGROUND: Medtronic.Lire moins >
Lire la suite >BACKGROUND: CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome. METHODS: In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1, 2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 μm2 RESULTS: We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) patients and diffusion MRI for 309 (18%) patients. Functional independence was worse in patients who had CTP versus those who had diffusion MRI, after adjustment for ischaemic core volume (odds ratio [OR] 0·47 [95% CI 0·30-0·72], p=0·0007), so the imaging modalities were not pooled. Increasing ischaemic core volume was associated with reduced likelihood of functional independence (CTP OR 0·77 [0·69-0·86] per 10 mL, pinteractioninteraction CONCLUSIONS: Estimated ischaemic core volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic core volume with age and expected imaging-to-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions. BACKGROUND: Medtronic.Lire moins >
Langue :
Anglais
Audience :
Internationale
Vulgarisation :
Non
Établissement(s) :
CHU Lille
CNRS
Inserm
Université de Lille
CNRS
Inserm
Université de Lille
Collections :
Équipe(s) de recherche :
Troubles cognitifs dégénératifs et vasculaires
Date de dépôt :
2019-11-27T14:34:14Z