title: Perfusion-based selection for endovascular reperfusion therapy in anterior circulation acute ischemic stroke.
abstract: OBJECTIVE
  Controversy exists about the role of perfusion imaging in patient selection for endovascular reperfusion therapy in acute ischemic stroke. We hypothesized that perfusion imaging versus noncontrast CT- based selection would be associated with improved functional outcomes at 3 months.
  
  
  METHODS
  We reviewed consecutive patients with anterior circulation strokes treated with endovascular reperfusion therapy within 8 hours and with baseline NIHSS score of ≥8. Baseline clinical data, selection mode (perfusion versus NCCT), angiographic data, complications, and modified Rankin Scale score at 3 months were collected. Using multivariable logistic regression, we assessed whether the mode of selection for endovascular reperfusion therapy (perfusion-based versus NCCT-based) was independently associated with good outcome.
  
  
  RESULTS
  Two-hundred fourteen patients (mean age, 67.2 years; median NIHSS score, 18; MCA occlusion 74% and ICA occlusion 26%) were included. Perfusion imaging was used in 76 (35.5%) patients (39 CT and 37 MR imaging). Perfusion imaging-selected patients were more likely to have good outcomes compared with NCCT-selected patients (55.3 versus 33.3%, P = .002); perfusion selection by CT was associated with similar outcomes as that by MR imaging (CTP, 56.; MR perfusion, 54.1%; P = .836). In multivariable analysis, CT or MR perfusion imaging selection remained strongly associated with good outcome (adjusted OR, 2.34; 95% CI, 1.22-4.47), independent of baseline severity and reperfusion.
  
  
  CONCLUSIONS
  In this multicenter study, patients with acute ischemic stroke who underwent perfusion imaging were more than 2-fold more likely to have good outcomes following endovascular reperfusion therapy. Randomized studies should compare perfusion imaging with NCCT imaging for patient selection for endovascular reperfusion therapy.
authors.affiliation: From the Departments of Neurology (S.P., R.A.B.) shyam.prabhakaran@northwestern.edu.
authors.forename: S
authors.initials: S
authors.lastname: Prabhakaran
authors.affiliation: Radiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois.
authors.forename: M
authors.initials: M
authors.lastname: Soltanolkotabi
authors.affiliation: Radiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois.
authors.forename: A R
authors.initials: AR
authors.lastname: Honarmand
authors.affiliation: From the Departments of Neurology (S.P., R.A.B.).
authors.forename: R A
authors.initials: RA
authors.lastname: Bernstein
authors.affiliation: Department of Neurology (V.H.L., J.J.C.), Rush University Medical Center, Chicago, Illinois.
authors.forename: V H
authors.initials: VH
authors.lastname: Lee
authors.affiliation: Department of Neurology (V.H.L., J.J.C.), Rush University Medical Center, Chicago, Illinois.
authors.forename: J J
authors.initials: JJ
authors.lastname: Conners
authors.affiliation: Department of Economics and Decision Sciences (F.D.-V.), Western Illinois University, Macomb, Illinois.
authors.forename: F
authors.initials: F
authors.lastname: Dehkordi-Vakil
authors.affiliation: Radiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois.
authors.forename: A
authors.initials: A
authors.lastname: Shaibani
authors.affiliation: Radiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois.
authors.forename: M C
authors.initials: MC
authors.lastname: Hurley
authors.affiliation: Radiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois.
authors.forename: S A
authors.initials: SA
authors.lastname: Ansari
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D002548:Cerebral Revascularization / Q000401:mortality / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome