title: Pretreatment diffusion-weighted imaging lesion volume predicts favorable outcome after intravenous thrombolysis with tissue-type plasminogen activator in acute ischemic stroke.
abstract: OBJECTIVE
  Stroke magnetic resonance imaging with perfusion and diffusion weighting has shown its potential to select patients likely to benefit from intravenous thrombolysis with tissue-type plasminogen activator (IV-tPA). We aimed to determine the predictors of favorable outcome in magnetic resonance imaging-selected, acute stroke patients treated with IV-tPA.
  
  
  METHODS
  We analyzed the data of acute ischemic stroke patients from a prospective, multicenter, observational study of magnetic resonance imaging-based IV-tPA treatment initiated ≤6 hours from symptom onset. Neurologic deficit on admission was assessed by the National Institutes of Health Stroke Scale. Clinical outcome was assessed after 90 days according to the modified Rankin Scale. Favorable outcome was defined as a modified Rankin Scale score of 0 to 1. Patients were compared regarding baseline parameters. Multivariate regression analysis was used to identify predictors of favorable outcome.
  
  
  RESULTS
  Of 174 patients, 83 (48%) reached a favorable outcome. They were younger (median age, 62 versus 67 years; P=0.001), had a lower National Institutes of Health Stroke Scale score on admission (median, 11 versus 15; P<0.001), and had smaller diffusion-weighted imaging lesions (median, 12.9 versus 20 mL; P=0.001). Perfusion-weighted imaging lesion volumes and onset-to-treatment time were comparable between the groups. Age (P=0.017), National Institutes of Health Stroke Scale score on admission (P<0.001), and diffusion-weighted imaging lesion volume (P=0.047) were identified as independent predictors of favorable outcome.
  
  
  CONCLUSIONS
  A lower age, lower National Institutes of Health Stroke Scale score on admission, and smaller pretreatment diffusion-weighted imaging lesion volume were found to be associated with a favorable outcome after treatment with IV-tPA. Pretreatment perfusion lesion volume and onset-to-treatment time were not associated with outcome when patients were selected for IV-tPA by magnetic resonance imaging within 6 hours of symptom onset.
authors.affiliation: Kopf- und Neurozentrum, Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. akruetzelmann@uke.uni-hamburg.de
authors.forename: Anna
authors.initials: A
authors.lastname: Kruetzelmann
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.forename: Jan
authors.initials: J
authors.lastname: Sobesky
authors.forename: Bastian
authors.initials: B
authors.lastname: Cheng
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenkranz
authors.forename: Joachim
authors.initials: J
authors.lastname: Röther
authors.forename: Peter D
authors.initials: PD
authors.lastname: Schellinger
authors.forename: Peter
authors.initials: P
authors.lastname: Ringleb
authors.forename: Christian
authors.initials: C
authors.lastname: Gerloff
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.forename: Götz
authors.initials: G
authors.lastname: Thomalla
mesh_terms: D000367:Age Factors; D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator