title: Clinical relevance and practical implications of trials of perfusion and angiographic imaging in patients with acute ischaemic stroke: a multicentre cohort imaging study.
abstract: BACKGROUND
  In randomised trials testing treatments for acute ischaemic stroke, imaging markers of tissue reperfusion and arterial recanalisation may provide early response indicators.
  
  
  OBJECTIVE
  To determine the predictive value of structural, perfusion and angiographic imaging for early and late clinical outcomes and assess practicalities in three comprehensive stroke centres.
  
  
  METHODS
  We recruited patients with potentially disabling stroke in three stroke centres, performed magnetic resonance (MR) or CT, including perfusion and angiography imaging, within 6 h, at 72 h and 1 month after stroke. We assessed the National Institutes of Health Stroke Scale (NIHSS) score serially and functional outcome at 3 months, tested associations between clinical variables and structural imaging, several perfusion parameters and angiography.
  
  
  RESULTS
  Among 83 patients, median age 71 (maximum 89), median NIHSS 7 (range 1-30), 38 (46%) received alteplase, 41 (49%) had died or were dependent at 3 months. Most baseline imaging was CT (76%); follow-up was MR (79%) despite both being available acutely. At presentation, perfusion lesion size varied considerably between parameters (p<0.0001); 40 (48%) had arterial occlusion. Arterial occlusion and baseline perfusion lesion extent were both associated with baseline NIHSS (p<0.0001). Recanalisation by 72 h was associated with 1 month NIHSS (p=0.0007) and 3 month functional outcome (p=0.048), whereas tissue reperfusion, using even the best perfusion parameter, was not (p=0.11, p=0.08, respectively).
  
  
  CONCLUSIONS
  Early recanalisation on angiography appeared to predict clinical outcome more directly than did tissue reperfusion. Acute assessment with CT and follow-up with MR was practical and feasible, did not preclude image analysis, and would enhance trial recruitment and generalisability of results.
authors: Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK. Joanna.wardlaw@ed.ac.uk
authors: Joanna M
authors: JM
authors: Wardlaw
authors: Keith W
authors: KW
authors: Muir
authors: Mary-Joan
authors: MJ
authors: Macleod
authors: Christopher
authors: C
authors: Weir
authors: Ferghal
authors: F
authors: McVerry
authors: Trevor
authors: T
authors: Carpenter
authors: Kirsten
authors: K
authors: Shuler
authors: Ralph
authors: R
authors: Thomas
authors: Paul
authors: P
authors: Acheampong
authors: Krishna
authors: K
authors: Dani
authors: Alison
authors: A
authors: Murray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000473:pathology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020765:Intracranial Arterial Diseases / Q000150:complications / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010477:Perfusion; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Stroke
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