Abstract
Objective
This study evaluated the associations of perfusion imaging collateral profiles with
radiographic and clinical outcome in late presenting, non-reperfused patients in the
DEFUSE 3 clinical trial.
Methods
Non-reperfused patients in both treatment arms were included. Baseline ischemic core,
Tmax >6s, and Tmax >10s perfusion volumes were calculated with RAPID software; infarct
volumes obtained 24 hours after randomization were manually determined from DWI or
CT. Substantial infarct growth was defined as a >25mL increase between baseline and
24-hour follow-up. Hypoperfusion Intensity Ratio (HIR) was defined as the proportion
of the Tmax >6s lesion with Tmax >10s delay; CBV index was calculated by RAPID from
mean CBV values within the Tmax >6s lesion compared to regions of normal CBV.
Results
Eighty-four patients were included. ROC analysis showed HIR ≥0.34 (AUC=0.68) and CBV
index ≤0.74 (AUC=0.72) optimally predicted substantial infarct growth in follow-up.
Median growth was 23.4 versus 73.2mL with HIR threshold of 0.34 (p=0.005), and 24.3
versus 58.7mL with CBV index threshold of 0.74 (p=0.004). If baseline HIR and CBV
index were both favorable, median growth was 21.7mL, 40.9mL if one was favorable,
and 108.2mL if both were unfavorable (p<0.001). Baseline perfusion profile was not
associated with 90-day functional outcome.
Conclusions
Perfusion collateral scores forecast infarct growth in late presenting, non-reperfused
ischemic stroke patients. These parameters may be useful for guiding transfer decisions,
such as need for repeat imaging upon thrombectomy center arrival, and may help identify
slow progressing patients more likely to have persistent salvageable ischemic tissue
beyond 24 hours.
Key Words
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Article info
Publication history
Published online: November 22, 2021
Accepted:
October 24,
2021
Received in revised form:
October 8,
2021
Received:
June 6,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106208
Copyright
© 2021 Elsevier Inc. All rights reserved.
