Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study.
OBJECTIVE
To determine whether prespecified baseline magnetic resonance imaging (MRI) profiles can identify stroke patients who have a robust clinical response after early reperfusion when treated 3 to 6 hours after symptom onset.


METHODS
We conducted a prospective, multicenter study of 74 consecutive stroke patients admitted to academic stroke centers in North America and Europe. An MRI scan was obtained immediately before and 3 to 6 hours after treatment with intravenous tissue plasminogen activator 3 to 6 hours after symptom onset. Baseline MRI profiles were used to categorize patients into subgroups, and clinical responses were compared based on whether early reperfusion was achieved.


RESULTS
Early reperfusion was associated with significantly increased odds of achieving a favorable clinical response in patients with a perfusion/diffusion mismatch (odds ratio, 5.4; p = 0.039) and an even more favorable response in patients with the Target Mismatch profile (odds ratio, 8.7; p = 0.011). Patients with the No Mismatch profile did not appear to benefit from early reperfusion. Early reperfusion was associated with fatal intracranial hemorrhage in patients with the Malignant profile.


CONCLUSIONS
For stroke patients treated 3 to 6 hours after onset, baseline MRI findings can identify subgroups that are likely to benefit from reperfusion therapies and can potentially identify subgroups that are unlikely to benefit or may be harmed.
Albers
Gregory W
GW
Department of Neurology and Neurological Sciences and the Stanford Stroke Center, Stanford University Medical Center, Stanford, CA.
Thijs
Vincent N
VN
Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
Wechsler
Lawrence
L
UPMC Stroke Institute and Department of Neurology, University of Pittsburgh, PA.
Kemp
Stephanie
S
Department of Neurology and Neurological Sciences and the Stanford Stroke Center, Stanford University Medical Center, Stanford, CA.
Schlaug
Gottfried
G
Division of Cerebrovascular Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA.
Skalabrin
Elaine
E
Department of Neurology, University of Utah, Salt Lake City, UT.
Bammer
Roland
R
Department of Radiology and the Stanford Stroke Center, Stanford University Medical Center, Stanford CA.
Kakuda
Wataru
W
Department of Neurology and Neurological Sciences and the Stanford Stroke Center, Stanford University Medical Center, Stanford, CA.
Lansberg
Maarten G
MG
Department of Neurology and Neurological Sciences and the Stanford Stroke Center, Stanford University Medical Center, Stanford, CA.
Shuaib
Ashfaq
A
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada (AS).
Coplin
William
W
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada (AS).
Hamilton
Scott
S
Department of Neurology and Neurological Sciences and the Stanford Stroke Center, Stanford University Medical Center, Stanford, CA.
Moseley
Michael
M
Department of Radiology and the Stanford Stroke Center, Stanford University Medical Center, Stanford CA.
Marks
Michael P
MP
Department of Radiology and the Stanford Stroke Center, Stanford University Medical Center, Stanford CA.
D000368:Aged; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator