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PT  - JOURNAL ARTICLE
AU  - Prabhakaran, S.
AU  - Soltanolkotabi, M.
AU  - Honarmand, A.R.
AU  - Bernstein, R.A.
AU  - Lee, V.H.
AU  - Conners, J.J.
AU  - Dehkordi-Vakil, F.
AU  - Shaibani, A.
AU  - Hurley, M.C.
AU  - Ansari, S.A.
TI  - Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke
AID  - 10.3174/ajnr.A3889
DP  - 2014 Apr 10
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2014/04/10/ajnr.A3889.short
4100  - http://www.ajnr.org/content/early/2014/04/10/ajnr.A3889.full
AB  - 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-2Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2ERTendovascular reperfusion therapyMRPMR perfusionTHRIVETotaled Health Risks in Vascular Events