TY - JOUR
T1 - Early infarct growth predicts long-term clinical outcome after thrombolysis
AU - Cho, Kyung Hee
AU - Kwon, Sun U.
AU - Lee, Deok Hee
AU - Shim, Woohyun
AU - Choi, Choonggon
AU - Kim, Sang Joon
AU - Suh, Dae Chul
AU - Kim, Jong S.
AU - Kang, Dong Wha
PY - 2012/5/15
Y1 - 2012/5/15
N2 - Background: Ischemic lesion growth may be a surrogate marker of clinical outcome, but no such interrelationship after thrombolysis has yet been determined. We evaluated the association between early infarct growth on diffusion-weighted imaging (DWI) and long-term clinical outcome after thrombolysis. Methods: We retrospectively reviewed outcomes in patients with acute middle cerebral artery territory stroke who had been treated with intravenous tissue plasminogen activator or intra-arterial urokinase. DWI lesion volumes were measured at baseline and within 7 days, and the difference was calculated. Clinical outcome was evaluated using the modified Rankin Scale (mRS) at 3 months. Good and poor clinical outcomes were defined as: a) mRS 0-1 vs. mRS 2-6, b) mRS 0-2 vs. mRS 3-6, and c) responder analysis which was influenced by the baseline National Institutes of Health Stroke Scale (NIHSS) scores: good and poor outcomes were defined as mRS 0 vs. mRS 1-6 if the baseline NIHSS score was < 8, mRS 0-1 vs. mRS 2-6 if the NIHSS score was 8-14, and mRS 0-2 vs. mRS 3-6 if the NIHSS score was > 14. The relationship between the ischemic lesion volume change and clinical outcome was explored. The cut-off value of infarct growth predicting long-term outcome was estimated using receiver operating characteristic analysis. Results: Of the 81 patients included, 67 (82.7%) showed lesion growth, and absolute growth was significantly related to poor outcomes (P < 0.001 all for mRS 2-6, mRS 3-6, and responder analysis). Multivariate analysis showed that absolute lesion growth was an independent predictor of poor outcome, defined as mRS 2-6 (P = 0.002; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10), mRS 3-6 (P = 0.001; OR, 1.06; 95% CI, 1.02-1.10), and poor outcome by responder analysis (P = 0.001; OR, 1.06; 95% CI, 1.03-1.10). The cut-off values of lesion growth that discriminated between good and poor outcomes were 14.11 cm3 for mRS 2-6; 15.87 cm 3 for mRS 3-6; and 14.11 cm3 in responder analysis. Conclusions: Early DWI lesion growth is an independent predictor of poor outcome after thrombolysis and may serve a potential surrogate marker of clinical outcome in acute stroke trials.
AB - Background: Ischemic lesion growth may be a surrogate marker of clinical outcome, but no such interrelationship after thrombolysis has yet been determined. We evaluated the association between early infarct growth on diffusion-weighted imaging (DWI) and long-term clinical outcome after thrombolysis. Methods: We retrospectively reviewed outcomes in patients with acute middle cerebral artery territory stroke who had been treated with intravenous tissue plasminogen activator or intra-arterial urokinase. DWI lesion volumes were measured at baseline and within 7 days, and the difference was calculated. Clinical outcome was evaluated using the modified Rankin Scale (mRS) at 3 months. Good and poor clinical outcomes were defined as: a) mRS 0-1 vs. mRS 2-6, b) mRS 0-2 vs. mRS 3-6, and c) responder analysis which was influenced by the baseline National Institutes of Health Stroke Scale (NIHSS) scores: good and poor outcomes were defined as mRS 0 vs. mRS 1-6 if the baseline NIHSS score was < 8, mRS 0-1 vs. mRS 2-6 if the NIHSS score was 8-14, and mRS 0-2 vs. mRS 3-6 if the NIHSS score was > 14. The relationship between the ischemic lesion volume change and clinical outcome was explored. The cut-off value of infarct growth predicting long-term outcome was estimated using receiver operating characteristic analysis. Results: Of the 81 patients included, 67 (82.7%) showed lesion growth, and absolute growth was significantly related to poor outcomes (P < 0.001 all for mRS 2-6, mRS 3-6, and responder analysis). Multivariate analysis showed that absolute lesion growth was an independent predictor of poor outcome, defined as mRS 2-6 (P = 0.002; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10), mRS 3-6 (P = 0.001; OR, 1.06; 95% CI, 1.02-1.10), and poor outcome by responder analysis (P = 0.001; OR, 1.06; 95% CI, 1.03-1.10). The cut-off values of lesion growth that discriminated between good and poor outcomes were 14.11 cm3 for mRS 2-6; 15.87 cm 3 for mRS 3-6; and 14.11 cm3 in responder analysis. Conclusions: Early DWI lesion growth is an independent predictor of poor outcome after thrombolysis and may serve a potential surrogate marker of clinical outcome in acute stroke trials.
KW - Acute stroke
KW - Diffusion-weighted imaging
KW - MRI
KW - Outcome
KW - Thrombolysis
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U2 - 10.1016/j.jns.2012.01.015
DO - 10.1016/j.jns.2012.01.015
M3 - Article
C2 - 22326365
AN - SCOPUS:84862789540
VL - 316
SP - 99
EP - 103
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
SN - 0022-510X
IS - 1-2
ER -