Impact of the Penumbral Pattern on Clinical Outcome in Patients with Successful Endovascular Revascularization

Jong Won Chung, Jun Yup Kim, Hong Kyun Park, Beom Joon Kim, Moon Ku Han, Jun Lee, Kang Ho Choi, Joon Tae Kim, Cheolkyu Jung, Jae Hyoung Kim, O. Ki Kwon, Chang Wan Oh, Juneyoung Lee, Hee Joon Bae

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)360-367
Number of pages8
JournalJournal of Stroke and Cerebrovascular Diseases
Volume26
Issue number2
DOIs
Publication statusPublished - 2017 Feb 1

Fingerprint

Stroke
Therapeutics
Diffusion Magnetic Resonance Imaging
Magnetic Resonance Angiography
Registries
Odds Ratio
Magnetic Resonance Imaging
Databases
Confidence Intervals

Keywords

  • endovascular treatment
  • penumbra
  • revascularization
  • Stroke
  • time

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of the Penumbral Pattern on Clinical Outcome in Patients with Successful Endovascular Revascularization. / Chung, Jong Won; Kim, Jun Yup; Park, Hong Kyun; Kim, Beom Joon; Han, Moon Ku; Lee, Jun; Choi, Kang Ho; Kim, Joon Tae; Jung, Cheolkyu; Kim, Jae Hyoung; Kwon, O. Ki; Oh, Chang Wan; Lee, Juneyoung; Bae, Hee Joon.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 26, No. 2, 01.02.2017, p. 360-367.

Research output: Contribution to journalArticle

Chung, JW, Kim, JY, Park, HK, Kim, BJ, Han, MK, Lee, J, Choi, KH, Kim, JT, Jung, C, Kim, JH, Kwon, OK, Oh, CW, Lee, J & Bae, HJ 2017, 'Impact of the Penumbral Pattern on Clinical Outcome in Patients with Successful Endovascular Revascularization', Journal of Stroke and Cerebrovascular Diseases, vol. 26, no. 2, pp. 360-367. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.09.031
Chung, Jong Won ; Kim, Jun Yup ; Park, Hong Kyun ; Kim, Beom Joon ; Han, Moon Ku ; Lee, Jun ; Choi, Kang Ho ; Kim, Joon Tae ; Jung, Cheolkyu ; Kim, Jae Hyoung ; Kwon, O. Ki ; Oh, Chang Wan ; Lee, Juneyoung ; Bae, Hee Joon. / Impact of the Penumbral Pattern on Clinical Outcome in Patients with Successful Endovascular Revascularization. In: Journal of Stroke and Cerebrovascular Diseases. 2017 ; Vol. 26, No. 2. pp. 360-367.
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abstract = "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.",
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AU - Chung, Jong Won

AU - Kim, Jun Yup

AU - Park, Hong Kyun

AU - Kim, Beom Joon

AU - Han, Moon Ku

AU - Lee, Jun

AU - Choi, Kang Ho

AU - Kim, Joon Tae

AU - Jung, Cheolkyu

AU - Kim, Jae Hyoung

AU - Kwon, O. Ki

AU - Oh, Chang Wan

AU - Lee, Juneyoung

AU - Bae, Hee Joon

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N2 - 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.

AB - 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.

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KW - penumbra

KW - revascularization

KW - Stroke

KW - time

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