title: Intravenous thrombolysis for patients with reverse magnetic resonance angiography and diffusion-weighted imaging mismatch: SAMURAI and NCVC rt-PA Registries.
abstract: OBJECTIVE
  The characteristics of reverse magnetic resonance angiography and diffusion-weighted imaging (MRA-DWI) mismatch (RMM), defined as a large DWI lesion in the absence of major artery occlusion (MAO), remain unknown, especially in patients treated with intravenous recombinant tissue plasminogen activator (rt-PA).
  
  
  METHODS
  Patients with stroke in the middle cerebral artery territory were included. Early ischaemic changes (EIC) were assessed with the Alberta Stroke Program Early CT Score on DWI (DWI-ASPECTS). All patients were divided into four groups based on the presence of MAO and a DWI-ASPECTS cut-off value of <7. RMM was defined as DWI-ASPECTS <7 without MAO. Clinical characteristics, symptomatic intracerebral hemorrhage (sICH) and favorable functional outcome (modified Rankin Scale score 0-2) at 90 days were compared amongst the four groups.
  
  
  RESULTS
  Of the 486 patients enrolled (167 women, median age 74 years, median initial National Institutes of Health Stroke Scale score 13), reverse MRA-DWI mismatch was observed in 24 (5%). Of the clinical characteristics, cardioembolism was the only factor that was independently associated with RMM [odds ratio (OR) 5.49, 95% confidence interval (CI) 1.25-24.1]. Multivariable analyses revealed that patients with RMM more commonly had sICH than those with DWI-ASPECTS ≥ 7 irrespective of the presence (OR 5.44, 95% CI 1.13-26.1) or absence (13.1, 2.07-83.3) of MAO, and they had a more favorable functional outcome than those with DWI-ASPECTS < 7 plus MAO (7.45, 2.39-23.2).
  
  
  CONCLUSIONS
  RMM was observed in 5% of patients treated with rt-PA and associated with cardioembolism. Patients with RMM may benefit from thrombolysis compared with those with EIC with MAO, although increment in the rate of sICH is a concern.
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: M
authors.initials: M
authors.lastname: Koga
authors.forename: K
authors.initials: K
authors.lastname: Kimura
authors.forename: K
authors.initials: K
authors.lastname: Nagatsuka
authors.forename: S
authors.initials: S
authors.lastname: Okuda
authors.forename: K
authors.initials: K
authors.lastname: Kario
authors.forename: Y
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Y
authors.initials: Y
authors.lastname: Okada
authors.forename: H
authors.initials: H
authors.lastname: Yamagami
authors.forename: E
authors.initials: E
authors.lastname: Furui
authors.forename: J
authors.initials: J
authors.lastname: Nakagawara
authors.forename: Y
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: T
authors.initials: T
authors.lastname: Okata
authors.forename: J
authors.initials: J
authors.lastname: Kobayashi
authors.forename: E
authors.initials: E
authors.lastname: Tanaka
authors.forename: K
authors.initials: K
authors.lastname: Minematsu
authors.forename: K
authors.initials: K
authors.lastname: Toyoda
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: acute ischaemic stroke; diffusion-weighted imaging; early ischaemic change; magnetic resonance angiography; prognosis; tissue plasminogen activator