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PT  - JOURNAL ARTICLE
AU  - Mourand, I.
AU  - Milhaud, D.
AU  - Arquizan, C.
AU  - Lobotesis, K.
AU  - Schaub, R.
AU  - Machi, P.
AU  - Ayrignac, X.
AU  - Eker, O.F.
AU  - Bonafé, A.
AU  - Costalat, V.
TI  - Favorable Bridging Therapy Based on DWI-FLAIR Mismatch in Patients with Unclear-Onset Stroke
AID  - 10.3174/ajnr.A4574
DP  - 2016 Jan 01
TA  - American Journal of Neuroradiology
PG  - 88--93
VI  - 37
IP  - 1
4099  - http://www.ajnr.org/content/37/1/88.short
4100  - http://www.ajnr.org/content/37/1/88.full
SO  - Am. J. Neuroradiol.2016 Jan 01; 37
AB  - BACKGROUND AND PURPOSE: Standard selection criteria for revascularization therapy usually exclude patients with unclear-onset stroke. Our aim was to evaluate the efficacy and safety of revascularization therapy in patients with unclear-onset stroke in the anterior circulation and to identify the predictive factors for favorable clinical outcome.MATERIALS AND METHODS: We retrospectively analyzed 41 consecutive patients presenting with acute stroke with unknown time of onset treated by intravenous thrombolysis and/or mechanical thrombectomy. Only patients without well-developed fluid-attenuated inversion recovery changes of acute diffusion lesions on MR imaging were enrolled. Twenty-one patients were treated by intravenous thrombolysis; 19 received, simultaneously, intravenous thrombolysis and mechanical thrombectomy (as a bridging therapy); and 1 patient, endovascular therapy alone. Clinical outcome was evaluated at 90 days by using the mRS. Mortality and symptomatic intracranial hemorrhage were also reported.RESULTS: Median patient age was 72 years (range, 17–89 years). Mean initial NIHSS score was 14.5 ± 5.7. Successful recanalization (TICI 2b–3) was assessed in 61% of patients presenting with an arterial occlusion, symptomatic intracranial hemorrhage occurred in 2 patients (4.9%), and 3 (7.3%) patients died. After 90 days, favorable outcome (mRS 0–2) was observed in 25 (61%) patients. Following multivariate analysis, initial NIHSS score (OR, 1.43; 95% CI, 1.13–1.82; P = .003) and bridging therapy (OR, 37.92; 95% CI, 2.43–591.35; P = .009) were independently associated with a favorable outcome at 3 months.CONCLUSIONS: The study demonstrates the safety and good clinical outcome of acute recanalization therapy in patients with acute stroke in the anterior circulation and an unknown time of onset and a DWI/FLAIR mismatch on imaging. Moreover, bridging therapy versus intravenous thrombolysis alone was independently associated with favorable outcome at 3 months.FATfirst found abnormal timeGRAPPAgeneralized autocalibrating partially parallel acquisitionIVTintravenous thrombolysissICHsymptomatic intracranial hemorrhage