Mundiyanapurath Sibu, Diatschuk Sascha, Loebel Sarah, Pfaff Johannes, Pham Mirko, Möhlenbruch Markus Alfred, Wick Wolfgang, Bendszus Martin, Ringleb Peter A, Radbruch Alexander
Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
German Cancer Research Centre, Department of Radiology, Heidelberg, Germany.
Eur J Radiol. 2017 Jun;91:82-87. doi: 10.1016/j.ejrad.2017.03.016. Epub 2017 Mar 25.
Patients with ischemic stroke and large vessel occlusion are assumed to benefit from endovascular therapy (ET) independent of the symptom onset-to-treatment time (OTT) if they present with a mismatch of diffusion- and perfusion-weighted imaging (DWI-PWI mismatch). We aimed at studying the influence of OTT on clinical outcome in these patients.
Retrospective database review in a tertiary care university hospital. All patients presented with proximal vessel occlusion of the anterior circulation and DWI-PWI mismatch. Primary outcome was the influence of OTT on modified Rankin scale (mRS) score three months after treatment, dichotomized in favourable (0-2) and unfavourable outcome (3-6). Secondary outcome was the effect of OTT on the shift of the mRS score. Patients treated within an early time window (<340min) and a late time window (≥340min) were compared.
139 patients were included. The rate of favourable outcome was significantly higher in patients who were treated in an early compared to those treated in a late time window (31 [49%] vs. 20 patients [27%], p=0.005). Adjusted multivariate logistic regression revealed that late treatment was an independent negative predictor of favourable outcome (odds ratio 0.39, confidence interval [0.18-0.84]; p=0.016). A shift towards higher mRS scores for late treatment was evident (p=0.015). In sensitivity analysis, OTT remained an independent predictor when evaluated as continuous variable. These findings were confirmed in patients with a comparable DWI-PWI mismatch according to the definitions from large trials (DEFUSE 2, DEFUSE 3, SWIFT-PRIME, EXTEND-IA).
Outcome of patients with comparable DWI-PWI mismatch is time-dependent.
对于缺血性卒中和大血管闭塞患者，如果其弥散加权成像与灌注加权成像不匹配（DWI-PWI不匹配），则假定他们可从血管内治疗（ET）中获益，而不受症状发作至治疗时间（OTT）的影响。我们旨在研究OTT对这些患者临床结局的影响。
在一家三级大学教学医院进行回顾性数据库分析。所有患者均表现为前循环近端血管闭塞且存在DWI-PWI不匹配。主要结局是OTT对治疗后3个月改良Rankin量表（mRS）评分的影响，分为良好结局（0-2分）和不良结局（3-6分）。次要结局是OTT对mRS评分变化的影响。比较了在早期时间窗（<340分钟）和晚期时间窗（≥340分钟）内接受治疗的患者。
纳入139例患者。早期接受治疗的患者良好结局发生率显著高于晚期接受治疗的患者（31例[49%] vs. 20例[27%]，p=0.005）。校正后的多因素逻辑回归显示，延迟治疗是良好结局的独立负性预测因素（比值比0.39，置信区间[0.18-0.84]；p=0.016）。延迟治疗后mRS评分升高明显（p=0.015）。在敏感性分析中，将OTT作为连续变量评估时，它仍然是独立预测因素。根据大型试验（DEFUSE 2、DEFUSE 3、SWIFT-PRIME、EXTEND-IA）的定义，在具有可比DWI-PWI不匹配的患者中也证实了这些发现。
具有可比DWI-PWI不匹配的患者结局与时间相关。
