title: Impact of the Penumbral Pattern on Clinical Outcome in Patients with Successful Endovascular Revascularization.
abstract: BACKGROUND
  In patients with acute ischemic stroke, the impact of penumbral patterns on clinical outcomes after endovascular treatment (EVT) remains controversial. We aimed to establish whether penumbral patterns are associated with clinical outcome after successful recanalization with EVT while adjusting for onset to revascularization time.
  
  
  METHODS
  Using a web-based, multicenter, prospective stroke registry database, we identified patients with acute ischemic stroke who underwent perfusion and diffusion magnetic resonance imaging (MRI) before EVT, had anterior circulation stroke, received EVT within 12 hours of symptom onset, and had successful revascularization confirmed during EVT. Based on pretreatment MRI, patients were stratified as having a favorable or nonfavorable penumbral pattern. Onset to revascularization time was dichotomized by median value. Primary outcome was functional independence (modified Rankin Scale score ≤2) at 90 days.
  
  
  RESULTS
  Among 121 eligible patients from three university hospitals, 104 (86.0%) had a favorable penumbral pattern, and the median time to revascularization was 271 minutes (interquartile range, 196-371). The functionally independent patient proportion was higher in those with a favorable penumbral pattern than in those without (53.8% versus 5.9%; P <.001), but was not different between early and late revascularization groups (49.2% versus 45.0%; P = .65). The favorable penumbral pattern was associated with functional independence after adjusting confounders (odds ratio, 23.25; 95% confidence interval: 1.58-341.99; P = .02). Time to revascularization did not modify the association (P for interaction, .53).
  
  
  CONCLUSIONS
  A favorable penumbral pattern is associated with improved functional independence in patients with endovascular revascularization, and the association was not time-dependent.
authors: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Jong-Won
authors: JW
authors: Chung
authors: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea.
authors: Jun Yup
authors: JY
authors: Kim
authors: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea.
authors: Hong-Kyun
authors: HK
authors: Park
authors: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea.
authors: Beom Joon
authors: BJ
authors: Kim
authors: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea.
authors: Moon-Ku
authors: MK
authors: Han
authors: Department of Neurology, Yeungnam University Hospital, Daegu, Republic of Korea.
authors: Jun
authors: J
authors: Lee
authors: Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors: Kang-Ho
authors: KH
authors: Choi
authors: Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors: Joon-Tae
authors: JT
authors: Kim
authors: Department of Radiology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea.
authors: Cheolkyu
authors: C
authors: Jung
authors: Department of Radiology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea.
authors: Jae Hyoung
authors: JH
authors: Kim
authors: Department of Neurosurgery, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea.
authors: O-Ki
authors: OK
authors: Kwon
authors: Department of Neurosurgery, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea.
authors: Chang Wan
authors: CW
authors: Oh
authors: Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
authors: Juneyoung
authors: J
authors: Lee
authors: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea. Electronic address: braindoc@snu.ac.kr.
authors: Hee-Joon
authors: HJ
authors: Bae
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000601:surgery; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012042:Registries; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Stroke; endovascular treatment; penumbra; revascularization; time