Background
In patients with acute ischemic stroke, the impact of penumbral patterns on clinical
outcomes after endovascular treatment (EVT) remains controversial. We aimed to establish
whether penumbral patterns are associated with clinical outcome after successful recanalization
with EVT while adjusting for onset to revascularization time.
Materials and Methods
Using a web-based, multicenter, prospective stroke registry database, we identified
patients with acute ischemic stroke who underwent perfusion and diffusion magnetic
resonance imaging (MRI) before EVT, had anterior circulation stroke, received EVT
within 12 hours of symptom onset, and had successful revascularization confirmed during
EVT. Based on pretreatment MRI, patients were stratified as having a favorable or
nonfavorable penumbral pattern. Onset to revascularization time was dichotomized by
median value. Primary outcome was functional independence (modified Rankin Scale score
≤2) at 90 days.
Findings
Among 121 eligible patients from three university hospitals, 104 (86.0%) had a favorable
penumbral pattern, and the median time to revascularization was 271 minutes (interquartile
range, 196-371). The functionally independent patient proportion was higher in those
with a favorable penumbral pattern than in those without (53.8% versus 5.9%; P < .001), but was not different between early and late revascularization groups (49.2%
versus 45.0%; P = .65). The favorable penumbral pattern was associated with functional independence
after adjusting confounders (odds ratio, 23.25; 95% confidence interval: 1.58-341.99;
P = .02). Time to revascularization did not modify the association (P for interaction, .53).
Conclusion
A favorable penumbral pattern is associated with improved functional independence
in patients with endovascular revascularization, and the association was not time-dependent.
Key Words
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Article info
Publication history
Published online: October 25, 2016
Accepted:
September 22,
2016
Received in revised form:
July 27,
2016
Received:
June 3,
2016
Footnotes
Grant support: The study is partly supported by a grant from the Korea Health 21 Research and Development Project, Ministry of Health and Welfare, Korea (HI10C2020) and by a grant from SK Chemicals. The sponsors of this study had no role in the study design, data collection, data analysis, data interpretation, or writing of the paper.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.09.031
Copyright
© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
