title: Magnetic resonance imaging-based endovascular versus medical stroke treatment for symptom onset up to 12 h.
abstract: BACKGROUND
  Recent trials have shown a clear benefit of endovascular therapy for stroke patients presenting within 6 h after stroke onset. Imaging-based selection may identify a cohort with a favorable response to endovascular therapy, in an even later time window.
  
  
  OBJECTIVE
  We performed an indirect comparison between outcomes seen in DEFUSE 2, a prospective cohort study of patients who received a baseline MRI before endovascular therapy, and a control group from AXIS 2 receiving standard medical care up to 12 h after symptom onset.
  
  
  METHODS
  Patients from AXIS 2 with a confirmed large vessel occlusion were selected as a control group for DEFUSE 2-patients. The primary endpoint was good functional outcome at day 90 (Modified Rankin Score 0-2). We performed a stratified analysis based on the presence of the target mismatch for both studies and reperfusion status in DEFUSE 2.
  
  
  RESULTS
  We compared good functional outcome in 108 patients from AXIS 2 and 99 patients from DEFUSE 2. In DEFUSE 2-patients with the target mismatch profile in whom reperfusion was achieved, the rate of good functional outcome was increased compared to target mismatch patients in AXIS 2, 54% versus 29% (OR 3.2, 95% CI 1.1-9.4). In target mismatch patients treated between 6 and 12 h after stroke onset, this association between study and good functional outcome remained present (OR 9.0, 95% CI 1.1-75.8).
  
  
  CONCLUSIONS
  This indirect comparison suggests that endovascular treatment resulting in substantial reperfusion is associated with improved outcome in target mismatch patients even beyond 6 h after stroke onset. Confirmation is needed from future clinical trials that randomize patients beyond the 6 h time window.
authors.affiliation: KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium VIB, Vesalius Research Center, Laboratory of Neurobiology, Leuven, Belgium University Hospitals Leuven, Department of Neurology, Leuven, Belgium anke.wouters@med.kuleuven.be.
authors.forename: Anke
authors.initials: A
authors.lastname: Wouters
authors.affiliation: KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium VIB, Vesalius Research Center, Laboratory of Neurobiology, Leuven, Belgium University Hospitals Leuven, Department of Neurology, Leuven, Belgium.
authors.forename: Robin
authors.initials: R
authors.lastname: Lemmens
authors.affiliation: Stanford Stroke Center, Stanford University, Palo Alto, USA.
authors.forename: Soren
authors.initials: S
authors.lastname: Christensen
authors.affiliation: Department of Radiology, University Hospitals of Leuven, Leuven, Belgium.
authors.forename: Guido
authors.initials: G
authors.lastname: Wilms
authors.affiliation: Laboratory for Epilepsy Research, Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium Medical Imaging Research Center, UZ Leuven, Leuven, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dupont
authors.affiliation: Stanford Stroke Center, Stanford University, Palo Alto, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.affiliation: Sygnis Bioscience, Heidelberg, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Schneider
authors.affiliation: GUIDED Development Heidelberg GmbH, Heidelberg, Germany.
authors.forename: Rico
authors.initials: R
authors.lastname: Laage
authors.affiliation: Neurocenter of Southern Switzerland, Lugano, Switzerland.
authors.forename: Carlo W
authors.initials: CW
authors.lastname: Cereda
authors.affiliation: Stanford Stroke Center, Stanford University, Palo Alto, USA.
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Lansberg
authors.affiliation: Stanford Stroke Center, Stanford University, Palo Alto, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.affiliation: KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium VIB, Vesalius Research Center, Laboratory of Neurobiology, Leuven, Belgium University Hospitals Leuven, Department of Neurology, Leuven, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Thijs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D020521:Stroke / Q000473:pathology / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome
keywords: Thrombectomy; acute stroke; cerebrovascular disease; diffusion-weighted magnetic resonance imaging; ischemic stroke; magnetic resonance imaging; perfusion-weighted magnetic resonance imaging; reperfusion; thrombolysis; treatment