title: Value of Computed Tomographic Perfusion-Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment.
abstract: OBJECTIVE
  The utility of computed tomographic perfusion (CTP)-based patient selection for intra-arterial treatment of acute ischemic stroke has not been proven in randomized trials and requires further study in a cohort that was not selected based on CTP. Our objective was to study the relationship between CTP-derived parameters and outcome and treatment effect in patients with acute ischemic stroke because of a proximal intracranial arterial occlusion.
  
  
  METHODS
  We included 175 patients who underwent CTP in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN). Association of CTP-derived parameters (ischemic-core volume, penumbra volume, and percentage ischemic core) with outcome was estimated with multivariable ordinal logistic regression as an adjusted odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale. Interaction between CTP-derived parameters and treatment effect was determined using multivariable ordinal logistic regression. Interaction with treatment effect was also tested for mismatch (core <70 mL; penumbra core >1.2; penumbra core >10 mL).
  
  
  RESULTS
  The adjusted odds ratio for improved functional outcome for ischemic core, percentage ischemic core, and penumbra were 0.79 per 10 mL (95% confidence interval: 0.71-0.89; P<0.001), 0.82 per 10% (95% confidence interval: 0.66-0.90; P=0.002), and 0.97 per 10 mL (96% confidence interval: 0.92-1.01; P=0.15), respectively. No significant interaction between any of the CTP-derived parameters and treatment effect was observed. We observed no significant interaction between mismatch and treatment effect.
  
  
  CONCLUSIONS
  CTP seems useful for predicting functional outcome, but cannot reliably identify patients who will not benefit from intra-arterial therapy.
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.). j.borst@amc.uva.nl.
authors.forename: Jordi
authors.initials: J
authors.lastname: Borst
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Olvert A
authors.initials: OA
authors.lastname: Berkhemer
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Yvo B W E M
authors.initials: YB
authors.lastname: Roos
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Ed
authors.initials: E
authors.lastname: van Bavel
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Wim H
authors.initials: WH
authors.lastname: van Zwam
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Oostenbrugge
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Marianne A A
authors.initials: MA
authors.lastname: van Walderveen
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
authors.affiliation: From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of Public Health (H.F.L.), Radiology (A.v.d.L.), and Neurology (O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, The Netherlands; and Department of Radiology, Texas Stroke Institute, Plano, TX (A.J.Y.).
authors.forename: Charles B L M
authors.initials: CB
authors.lastname: Majoie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D055420:Perfusion Imaging / Q000379:methods; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: computed tomography; interventional neuroradiology; ischemic stroke; perfusion imaging; stroke