Title :

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

Author(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 [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 W E M. [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]

Journal title :

The Lancet. Neurology

Abbreviated title :

Lancet Neurol

Publication date :

2018-11-06

ISSN :

1474-4465

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [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 ...
Show more >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.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Université de Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2019-12-09T16:48:37Z