title: Impact of diffusion-weighted imaging lesion volume on the success of endovascular reperfusion therapy.
abstract: OBJECTIVE
  Diffusion-weighted imaging (DWI) lesion volume is associated with poor outcome after thrombolysis, and it is unclear whether endovascular therapies are beneficial for large DWI lesion. Our aim was to assess the impact of pretreatment DWI lesion volume on outcomes after endovascular therapy, with a special emphasis on patients with complete recanalization.
  
  
  METHODS
  We analyzed data collected between April 2007 and November 2011 in a prospective clinical registry. All acute ischemic stroke patients with complete occlusion of internal carotid artery or middle cerebral artery treated by endovascular therapy were included. DWI lesion volumes were measured by the RAPID software. Favorable outcome was defined by modified Rankin Scale of 0 to 2 at 90 days.
  
  
  RESULTS
  A total of 139 acute ischemic stroke patients were included. Median DWI lesion volume was 14 cc (interquartile range, 5-43) after a median onset time to imaging of 110 minutes (interquartile range, 77-178). Higher volume was associated with less favorable outcome (adjusted odds ratio, 0.55; 95% confidence interval, 0.31-0.96). A complete recanalization was achieved in 65 (47%) patients after a median onset time of 238 minutes (interquartile range, 206-285). After adjustment for volume, complete recanalization was associated with more favorable outcome (adjusted odds ratio, 6.32; 95% confidence interval, 2.90-13.78). After stratification of volume by tertiles, complete recanalization was similarly associated with favorable outcome in the upper 2 tertiles (P<0.005).
  
  
  CONCLUSIONS
  Our results emphasize the importance of initial DWI volume and recanalization on clinical outcome after endovascular treatment. Large DWI lesions may still benefit from recanalization in selected patients.
authors.affiliation: Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, CA, USA.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Olivot
authors.forename: Pascal J
authors.initials: PJ
authors.lastname: Mosimann
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Manabu
authors.initials: M
authors.lastname: Inoue
authors.forename: Elena
authors.initials: E
authors.lastname: Meseguer
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Desilles
authors.forename: Aymeric
authors.initials: A
authors.lastname: Rouchaud
authors.forename: Isabelle F
authors.initials: IF
authors.lastname: Klein
authors.forename: Matus
authors.initials: M
authors.lastname: Straka
authors.forename: Roland
authors.initials: R
authors.lastname: Bammer
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000473:pathology; D002343:Carotid Artery, Internal / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: acute stroke syndromes; diffusion-weighted imaging; endovascular reperfusion; thrombolysis