title: Multivariate dynamic prediction of ischemic infarction and tissue salvage as a function of time and degree of recanalization.
abstract: Benefit of endovascular recanalization beyond established treatment time windows likely exists in select stroke patients. However, there is currently no imaging model that predicts infarction adjusting for elapsed time between the pathologic snapshot of admission imaging until endovascular recanalization. We trained and cross validated a multivariate generalized linear model (GLM) that uses computer tomography perfusion and clinical data to quantify patient-specific dynamic change of tissue infarction depending on degree and time of recanalization. Multicenter data of 161 patients with proximal anterior circulation occlusion undergoing endovascular therapy were included. Multivariate voxelwise infarct probability was calculated within the GLM. The effect of increasing time to treatment and degree of recanalization on voxelwise infarction was calculated in each patient. Tissue benefit of successful relative to unsuccessful recanalization was shown up to 15 hours after onset in individual patients and decreased nonlinearly with time. On average, the relative reduction of infarct volume at the treatment interval of 5 hours was 53% and this salvage effect decreased by 5% units per hour to <5% after 10 additional hours to treatment. Treatment time-adjusted multivariate prediction of infarction by perfusion and clinical status may identify patients who benefit from extended time to recanalization therapy.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department of Clinical Radiology, University of Muenster, Muenster, Germany.|Institute of Neuroradiology, University Medical Center Schleswig Holstein, Lübeck, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Kemmling
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Flottmann
authors.affiliation: Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Nils Daniel
authors.initials: ND
authors.lastname: Forkert
authors.affiliation: Department of Neurology, University of Muenster, Muenster, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Minnerup
authors.affiliation: Department of Clinical Radiology, University of Muenster, Muenster, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Goetz
authors.initials: G
authors.lastname: Thomalla
authors.affiliation: Department of Neuroradiology, Asklepios Hospital Altona, Hamburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Eckert
authors.affiliation: Department of Neuroradiology, University of Medicine Goettingen, Goettingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Knauth
authors.affiliation: Department of Neuroradiology, University of Medicine Goettingen, Goettingen, Germany.
authors.forename: Marios
authors.initials: M
authors.lastname: Psychogios
authors.affiliation: Institute of Diagnostic Radiology and Neuroradiology, University of Medicine Greifswald, Greifswald, Germany.
authors.forename: Soenke
authors.initials: S
authors.lastname: Langner
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020521:Stroke / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors