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<meta name="DC.Title" content="Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3889" />
<meta name="DC.Date" content="2014-04-10" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Controversy exists about the role of perfusion imaging in patient selection for endovascular reperfusion therapy in acute ischemic stroke. We hypothesized that perfusion imaging versus noncontrast CT- based selection would be associated with improved functional outcomes at 3 months.

MATERIALS AND METHODS: We reviewed consecutive patients with anterior circulation strokes treated with endovascular reperfusion therapy within 8 hours and with baseline NIHSS score of ≥8. Baseline clinical data, selection mode (perfusion versus NCCT), angiographic data, complications, and modified Rankin Scale score at 3 months were collected. Using multivariable logistic regression, we assessed whether the mode of selection for endovascular reperfusion therapy (perfusion-based versus NCCT-based) was independently associated with good outcome.

RESULTS: Two-hundred fourteen patients (mean age, 67.2 years; median NIHSS score, 18; MCA occlusion 74% and ICA occlusion 26%) were included. Perfusion imaging was used in 76 (35.5%) patients (39 CT and 37 MR imaging). Perfusion imaging–selected patients were more likely to have good outcomes compared with NCCT-selected patients (55.3 versus 33.3%, P = .002); perfusion selection by CT was associated with similar outcomes as that by MR imaging (CTP, 56.; MR perfusion, 54.1%; P = .836). In multivariable analysis, CT or MR perfusion imaging selection remained strongly associated with good outcome (adjusted OR, 2.34; 95% CI, 1.22–4.47), independent of baseline severity and reperfusion.

CONCLUSIONS: In this multicenter study, patients with acute ischemic stroke who underwent perfusion imaging were more than 2-fold more likely to have good outcomes following endovascular reperfusion therapy. Randomized studies should compare perfusion imaging with NCCT imaging for patient selection for endovascular reperfusion therapy.

### Abbreviations

DEFUSE-2
:   Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2
ERT
:   endovascular reperfusion therapy
MRP
:   MR perfusion
THRIVE
:   Totaled Health Risks in Vascular Events" />
<meta name="DC.Contributor" content="S. Prabhakaran" />
<meta name="DC.Contributor" content="M. Soltanolkotabi" />
<meta name="DC.Contributor" content="A.R. Honarmand" />
<meta name="DC.Contributor" content="R.A. Bernstein" />
<meta name="DC.Contributor" content="V.H. Lee" />
<meta name="DC.Contributor" content="J.J. Conners" />
<meta name="DC.Contributor" content="F. Dehkordi-Vakil" />
<meta name="DC.Contributor" content="A. Shaibani" />
<meta name="DC.Contributor" content="M.C. Hurley" />
<meta name="DC.Contributor" content="S.A. Ansari" />
<meta name="article:published_time" content="2014-04-10" />
<meta name="article:section" content="BRAIN" />
<meta name="citation_title" content="Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Controversy exists about the role of perfusion imaging in patient selection for endovascular reperfusion therapy in acute ischemic stroke. We hypothesized that perfusion imaging versus noncontrast CT- based selection would be associated with improved functional outcomes at 3 months.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We reviewed consecutive patients with anterior circulation strokes treated with endovascular reperfusion therapy within 8 hours and with baseline NIHSS score of ≥8. Baseline clinical data, selection mode (perfusion versus NCCT), angiographic data, complications, and modified Rankin Scale score at 3 months were collected. Using multivariable logistic regression, we assessed whether the mode of selection for endovascular reperfusion therapy (perfusion-based versus NCCT-based) was independently associated with good outcome.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Two-hundred fourteen patients (mean age, 67.2 years; median NIHSS score, 18; MCA occlusion 74% and ICA occlusion 26%) were included. Perfusion imaging was used in 76 (35.5%) patients (39 CT and 37 MR imaging). Perfusion imaging–selected patients were more likely to have good outcomes compared with NCCT-selected patients (55.3 versus 33.3%, &lt;i&gt;P&lt;/i&gt; = .002); perfusion selection by CT was associated with similar outcomes as that by MR imaging (CTP, 56.; MR perfusion, 54.1%; &lt;i&gt;P&lt;/i&gt; = .836). In multivariable analysis, CT or MR perfusion imaging selection remained strongly associated with good outcome (adjusted OR, 2.34; 95% CI, 1.22–4.47), independent of baseline severity and reperfusion.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;In this multicenter study, patients with acute ischemic stroke who underwent perfusion imaging were more than 2-fold more likely to have good outcomes following endovascular reperfusion therapy. Randomized studies should compare perfusion imaging with NCCT imaging for patient selection for endovascular reperfusion therapy.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2014/04/10" />
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<meta name="citation_author" content="S. Prabhakaran" />
<meta name="citation_author_institution" content="From the Departments of Neurology (S.P., R.A.B.) and Radiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois; and Department of Neurology (V.H.L., J.J.C.), Rush University Medical Center, Chicago, Illinois; and Department of Economics and Decision Sciences (F.D.-V.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="M. Soltanolkotabi" />
<meta name="citation_author_institution" content="From the Departments of Neurology (S.P., R.A.B.) and Radiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois; and Department of Neurology (V.H.L., J.J.C.), Rush University Medical Center, Chicago, Illinois; and Department of Economics and Decision Sciences (F.D.-V.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="A.R. Honarmand" />
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<meta name="citation_author" content="R.A. Bernstein" />
<meta name="citation_author_institution" content="From the Departments of Neurology (S.P., R.A.B.) and Radiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois; and Department of Neurology (V.H.L., J.J.C.), Rush University Medical Center, Chicago, Illinois; and Department of Economics and Decision Sciences (F.D.-V.), Western Illinois University, Macomb, Illinois." />
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<meta name="citation_author" content="J.J. Conners" />
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<meta name="citation_author" content="F. Dehkordi-Vakil" />
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<meta name="citation_author" content="A. Shaibani" />
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<meta name="citation_author" content="M.C. Hurley" />
<meta name="citation_author_institution" content="From the Departments of Neurology (S.P., R.A.B.) and Radiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois; and Department of Neurology (V.H.L., J.J.C.), Rush University Medical Center, Chicago, Illinois; and Department of Economics and Decision Sciences (F.D.-V.), Western Illinois University, Macomb, Illinois." />
<meta name="citation_author" content="S.A. Ansari" />
<meta name="citation_author_institution" content="From the Departments of Neurology (S.P., R.A.B.) and Radiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois; and Department of Neurology (V.H.L., J.J.C.), Rush University Medical Center, Chicago, Illinois; and Department of Economics and Decision Sciences (F.D.-V.), Western Illinois University, Macomb, Illinois." />
<meta name="twitter:title" content="Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Controversy exists about the role of perfusion imaging in patient selection for endovascular reperfusion therapy in acute ischemic stroke. We hypothesized that perfusion imaging versus noncontrast CT- based selection would be associated with improved functional outcomes at 3 months.

MATERIALS AND METHODS: We reviewed consecutive patients with anterior circulation strokes treated with endovascular reperfusion therapy within 8 hours and with baseline NIHSS score of ≥8. Baseline clinical data, selection mode (perfusion versus NCCT), angiographic data, complications, and modified Rankin Scale score at 3 months were collected. Using multivariable logistic regression, we assessed whether the mode of selection for endovascular reperfusion therapy (perfusion-based versus NCCT-based) was independently associated with good outcome.

RESULTS: Two-hundred fourteen patients (mean age, 67.2 years; median NIHSS score, 18; MCA occlusion 74% and ICA occlusion 26%) were included. Perfusion imaging was used in 76 (35.5%) patients (39 CT and 37 MR imaging). Perfusion imaging–selected patients were more likely to have good outcomes compared with NCCT-selected patients (55.3 versus 33.3%, P = .002); perfusion selection by CT was associated with similar outcomes as that by MR imaging (CTP, 56.; MR perfusion, 54.1%; P = .836). In multivariable analysis, CT or MR perfusion imaging selection remained strongly associated with good outcome (adjusted OR, 2.34; 95% CI, 1.22–4.47), independent of baseline severity and reperfusion.

CONCLUSIONS: In this multicenter study, patients with acute ischemic stroke who underwent perfusion imaging were more than 2-fold more likely to have good outcomes following endovascular reperfusion therapy. Randomized studies should compare perfusion imaging with NCCT imaging for patient selection for endovascular reperfusion therapy.

### Abbreviations

DEFUSE-2
:   Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2
ERT
:   endovascular reperfusion therapy
MRP
:   MR perfusion
THRIVE
:   Totaled Health Risks in Vascular Events" />
<meta name="og-title" property="og:title" content="Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2014/04/10/ajnr.A3889" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Controversy exists about the role of perfusion imaging in patient selection for endovascular reperfusion therapy in acute ischemic stroke. We hypothesized that perfusion imaging versus noncontrast CT- based selection would be associated with improved functional outcomes at 3 months.

MATERIALS AND METHODS: We reviewed consecutive patients with anterior circulation strokes treated with endovascular reperfusion therapy within 8 hours and with baseline NIHSS score of ≥8. Baseline clinical data, selection mode (perfusion versus NCCT), angiographic data, complications, and modified Rankin Scale score at 3 months were collected. Using multivariable logistic regression, we assessed whether the mode of selection for endovascular reperfusion therapy (perfusion-based versus NCCT-based) was independently associated with good outcome.

RESULTS: Two-hundred fourteen patients (mean age, 67.2 years; median NIHSS score, 18; MCA occlusion 74% and ICA occlusion 26%) were included. Perfusion imaging was used in 76 (35.5%) patients (39 CT and 37 MR imaging). Perfusion imaging–selected patients were more likely to have good outcomes compared with NCCT-selected patients (55.3 versus 33.3%, P = .002); perfusion selection by CT was associated with similar outcomes as that by MR imaging (CTP, 56.; MR perfusion, 54.1%; P = .836). In multivariable analysis, CT or MR perfusion imaging selection remained strongly associated with good outcome (adjusted OR, 2.34; 95% CI, 1.22–4.47), independent of baseline severity and reperfusion.

CONCLUSIONS: In this multicenter study, patients with acute ischemic stroke who underwent perfusion imaging were more than 2-fold more likely to have good outcomes following endovascular reperfusion therapy. Randomized studies should compare perfusion imaging with NCCT imaging for patient selection for endovascular reperfusion therapy.

### Abbreviations

DEFUSE-2
:   Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2
ERT
:   endovascular reperfusion therapy
MRP
:   MR perfusion
THRIVE
:   Totaled Health Risks in Vascular Events" />
<meta name="og-type" property="og:type" content="article" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S. Prabhakaran</span>, <span class="highwire-citation-author" data-delta="1">M. Soltanolkotabi</span>, <span class="highwire-citation-author" data-delta="2">A.R. Honarmand</span>, <span class="highwire-citation-author" data-delta="3">R.A. Bernstein</span>, <span class="highwire-citation-author" data-delta="4">V.H. Lee</span>, <span class="highwire-citation-author" data-delta="5">J.J. Conners</span>, <span class="highwire-citation-author" data-delta="6">F. Dehkordi-Vakil</span>, <span class="highwire-citation-author" data-delta="7">A. Shaibani</span>, <span class="highwire-citation-author" data-delta="8">M.C. Hurley</span> and <span class="highwire-citation-author" data-delta="9">S.A. Ansari</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2014,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3889 </span></div>
  
  
  
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