title: Impact of Initial Diffusion-Weighted Imaging Lesion Growth Rate on the Success of Endovascular Reperfusion Therapy.
abstract: Initial diffusion-weighted imaging lesion growth rate (IGR) assessed by diffusion-weighted imaging lesion volume divided by the delay from onset to magnetic resonance imaging offers an estimate of early brain infarction progression. We investigated the impact of IGR on the rate of favorable outcome according to the occurrence of a successful endovascular revascularization within 6 hours after onset in patients experiencing an acute brain infarction complicating internal carotid artery terminus/middle cerebral artery M1 occlusion.
  
  
  
  The primary study end point was a favorable outcome defined by a modified Rankin Scale score of ≤2, 90 days after onset. A Thrombolysis in Cerebral Infarction score 2b/3 defined a successful recanalization.
  
  
  
  A total of 166 patients were included. Median IGR was 7 mL/h (interquartile range, 2-26). Sixty-eight patients (41%) experienced a favorable outcome. After adjustment on age, systolic blood pressure, vessel site occlusion, National Institutes of Health Stroke Scale, and antithrombotic medication, increase in IGR was associated with a decreased occurrence of favorable outcome with an odds ratio per SD increase of 0.60 (95% confidence interval, 0.38-0.94; P=0.03). A successful recanalization was achieved among 56% of the patients after a median delay of 251 minutes (interquartile range, 211-291 minutes). Increasing IGR was associated with a decreased favorable outcome only when a successful recanalization was not achieved (adjusted odds ratio, 0.32; 95% confidence interval, 0.12-0.85; P=0.02).
  
  
  
  Proximal internal carotid artery/M1 occlusion did result into a wide range of IGR within 6 hours after onset. Increasing IGR was associated with a lower rate of favorable outcome after endovascular treatment overall and when a successful recanalization was not achieved.
authors: From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d'Accueil et de Traitement de l'Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et Qualité des Soins, France (J.L.); Stanford Stroke Center, Stanford University, CA (M.M.).
authors: Jean-Marc
authors: JM
authors: Olivot
authors: From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d'Accueil et de Traitement de l'Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et Qualité des Soins, France (J.L.); Stanford Stroke Center, Stanford University, CA (M.M.).
authors: Leila
authors: L
authors: Sissani
authors: From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d'Accueil et de Traitement de l'Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et Qualité des Soins, France (J.L.); Stanford Stroke Center, Stanford University, CA (M.M.).
authors: Elena
authors: E
authors: Meseguer
authors: From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d'Accueil et de Traitement de l'Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et Qualité des Soins, France (J.L.); Stanford Stroke Center, Stanford University, CA (M.M.).
authors: Manabu
authors: M
authors: Inoue
authors: From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d'Accueil et de Traitement de l'Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et Qualité des Soins, France (J.L.); Stanford Stroke Center, Stanford University, CA (M.M.).
authors: Julien
authors: J
authors: Labreuche
authors: From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d'Accueil et de Traitement de l'Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et Qualité des Soins, France (J.L.); Stanford Stroke Center, Stanford University, CA (M.M.).
authors: Michael
authors: M
authors: Mlynash
authors: From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d'Accueil et de Traitement de l'Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et Qualité des Soins, France (J.L.); Stanford Stroke Center, Stanford University, CA (M.M.).
authors: Pierre
authors: P
authors: Amarenco
authors: From the Acute Stroke Unit, Toulouse University Hospital, Toulouse Neuro Imaging Center (UMR 1214), Toulouse University Hospital, France (J.-M.O.); UMR 1148 et Centre d'Accueil et de Traitement de l'Attaque Cérébrale, CHU Bichat, Paris, France (L.S., E.M., P.A., M.M.); NCVC Stroke Center, National Cerebral and Cardiovascular Center, Fujishirodai 5-7-1, Suita, Osaka 565-8565, Japan (M.I.); and Department of Biostatistics, Université de Lille, CHU Lille, EA 2694 - Santé Publique Épidémiologie et Qualité des Soins, France (J.L.); Stanford Stroke Center, Stanford University, CA (M.M.).
authors: Mikael
authors: M
authors: Mazighi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000628:therapy; D038524:Diffusion Magnetic Resonance Imaging; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: diffusion magnetic resonance imaging; magnetic resonance imaging; thrombectomy