title: Reperfusion within 6 hours outperforms recanalization in predicting penumbra salvage, lesion growth, final infarct, and clinical outcome.
abstract: OBJECTIVE
  The relative merits of reperfusion versus recanalization to predict tissue and clinical outcomes in anterior circulation stroke have been previously assessed using data acquired >12 hours postonset. To avoid late-occurring confounders such as non-nutritional reperfusion, futile recanalization and no-reflow phenomenon, we performed ultraearly assessment of reperfusion and recanalization.
  
  
  METHODS
  From a multicenter prospective database, 46 patients with acute magnetic resonance angiography-visible occlusion and in whom both reperfusion and recanalization were assessed on follow-up magnetic resonance imaging ≤6 hours of symptom onset were identified. Multiple linear regressions modeled salvaged penumbra, diffusion-weighted imaging lesion growth, and final infarct at 1 month using baseline clinical and imaging parameters and acute reperfusion or recanalization. Best predictors were determined with the Akaike information criterion. Univariate and multivariate logistic regressions identified the clinical and imaging predictors of clinical outcome.
  
  
  RESULTS
  Admission magnetic resonance imaging showed M1 occlusion in 15 (33%) patients; median penumbra volume was 13.4 mL. Acute reperfusion was observed in 27 (59%) patients; 42% of nonrecanalized patients demonstrated reperfusion. The dichotomized classification of reperfusion and recanalization was discordant (P=0.0002). Reperfusion≤6 hours was a significant (P<0.05) predictor of increased penumbra salvage, reduced lesion growth, and final infarct size. Recanalization did not improve model accuracy. Reperfusion, but not recanalization, was significantly associated with good clinical outcome in logistic regressions.
  
  
  CONCLUSIONS
  Reperfusion≤6 hours was consistently superior to recanalization in predicting tissue and clinical outcome. Reperfusion without recanalization was frequent and probably related to retrograde reperfusion through leptomeningeal collaterals. Acute reperfusion was the strongest predictor of, and may therefore, represent a reliable surrogate for, clinical outcome.
authors.affiliation: From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.). tae-hee.cho@chu-lyon.fr.
authors.forename: Tae-Hee
authors.initials: TH
authors.lastname: Cho
authors.affiliation: From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.).
authors.forename: Norbert
authors.initials: N
authors.lastname: Nighoghossian
authors.affiliation: From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.).
authors.forename: Irene Klærke
authors.initials: IK
authors.lastname: Mikkelsen
authors.affiliation: From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.).
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.affiliation: From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.).
authors.forename: Marc
authors.initials: M
authors.lastname: Hermier
authors.affiliation: From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.).
authors.forename: Salvador
authors.initials: S
authors.lastname: Pedraza
authors.affiliation: From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.).
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.affiliation: From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.).
authors.forename: Leif
authors.initials: L
authors.lastname: Østergaard
authors.affiliation: From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.).
authors.forename: Yves
authors.initials: Y
authors.lastname: Berthezène
authors.affiliation: From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.).
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
mesh_terms: D000368:Aged; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000628:therapy; D002533:Cerebral Angiography; D016208:Databases, Factual; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D015424:Reperfusion; D013997:Time Factors; D016896:Treatment Outcome
keywords: magnetic resonance imaging; reperfusion