Mismatch Profile Influences Outcome After Mechanical Thrombectomy.

Jean-Marc Olivot, Jean-François Albucher, Adrien Guenego, Claire Thalamas, Michael Mlynash, Vanessa Rousseau, Amel Drif, Soren Christensen, Agnes Sommet, Alain Viguier, Jean Darcourt, Lionel Calvière, Patrice Menegon, Nicolas Raposo, Anne-Christine Januel, Fabrice Bonneville, Thomas Tourdias , Mikael Mazighi, Igor Sibon , Gregory W. Albers, Christophe Cognard, François Chollet, Marianne Barbieux, Caterina Michelozzi, Philippe Tall, François Caparros, Brigitte Pouzet, Fabienne Calvas, Monique Galitzki, Pauline Renou, François Rouanet, Jerome Berge, Gauthier Marnat, Ludovic Lucas, Cyrielle Coignon, Sharmila Sagnier, Sabrina Debruxelle, Sylvain Ledure
Stroke. 2021-01-01; 52(1): 232-240
DOI: 10.1161/strokeaha.120.031929

Read on PubMed

Background and Purpose:
Mechanical thrombectomy (MT) is the recommended treatment for acute ischemic stroke caused by anterior circulation large vessel occlusion. However, despite a high rate of reperfusion, the clinical response to successful MT remains highly variable in the early time window where optimal imaging selection criteria have not been established. We hypothesize that the baseline perfusion imaging profile may help forecast the clinical response to MT in this setting.

We conducted a prospective multicenter cohort study of patients with large vessel occlusion–related acute ischemic stroke treated by MT within 6 hours. Treatment decisions and the modified Rankin Scale evaluation at 3 months were performed blinded to the results of baseline perfusion imaging. Study groups were defined a posteriori based on predefined imaging profiles: target mismatch (TMM; core volume <70 mL/mismatch ratio >1.2 and mismatch volume >10 mL) versus no TMM or mismatch (MM; mismatch ratio >1.2 and volume >10 mL) versus no MM. Functional recovery (modified Rankin Scale, 0–2) at 3 months was compared based on imaging profile at baseline and whether reperfusion (modified Thrombolysis in Cerebral Infarction 2bc3) was achieved.

Two hundred eighteen patients (mean age, 71±15 years; median National Institutes of Health Stroke Scale score, 17 [interquartile range, 12–21]) were enrolled. Perfusion imaging profiles were 71% TMM and 82% MM. The rate of functional recovery was 54% overall. Both TMM and MM profiles were independently associated with a higher rate on functional recovery at 3 months Adjusted odds ratios were 3.3 (95% CI, 1.4–7.9) for TMM and 5.9 (95% CI, 1.8–19.6) for MM. Reperfusion (modified Thrombolysis in Cerebral Infarction 2bc3) was achieved in 86% and was more frequent in TMM and MM patients. Reperfusion was associated with a higher rate of functional recovery in MM and TMM patients but not among those with no MM.

In this cohort study, about 80% of the patients with a large vessel occlusion–related acute ischemic stroke had evidence of penumbra, regardless of infarction volume. Perfusion imaging profiles predict the clinical response to MT.

Know more about