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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="2014-03-27" />
<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. Honarmond" />
<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="2014-03-27" />
<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;" />
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<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." />
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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." />
<meta name="citation_author" content="V.H. Lee" />
<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="J.J. Conners" />
<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="F. Dehkordi-Vakil" />
<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. Shaibani" />
<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.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/2014/03/27/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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      <h1 class="highwire-cite-title" id="page-title">Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke</h1>  
    	<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. Honarmond</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">March 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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<div id="hw-article-author-popups-top-node-50589--61383029467" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S. Prabhakaran </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>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.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BPrabhakaran%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Prabhakaran%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BPrabhakaran%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M. Soltanolkotabi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>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.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BSoltanolkotabi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Soltanolkotabi%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.%2BSoltanolkotabi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">A.R. Honarmond </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>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.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.R.%2BHonarmond%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Honarmond%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.R.%2BHonarmond%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">R.A. Bernstein </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>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.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.A.%2BBernstein%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bernstein%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.A.%2BBernstein%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">V.H. Lee </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>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.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=V.H.%2BLee%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lee%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AV.H.%2BLee%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">J.J. Conners </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>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.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.J.%2BConners%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Conners%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.J.%2BConners%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">F. 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<p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> 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.</p></div>
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<p id="p-2"><strong>MATERIALS AND METHODS:</strong> 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.</p></div>
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<p id="p-3"><strong>RESULTS:</strong> 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%, <em>P</em> = .002); perfusion selection by CT was associated with similar outcomes as that by MR imaging (CTP, 56.; MR perfusion, 54.1%; <em>P</em> = .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.</p></div>
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<p id="p-4"><strong>CONCLUSIONS:</strong> 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.</p>
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<h3>Abbreviations</h3>
<dl id="def-list-1"><dt id="def-item-1">DEFUSE-2<span class="def-item-dt-sep"></span></dt><dd>Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">ERT<span class="def-item-dt-sep"></span></dt><dd>endovascular reperfusion therapy<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">MRP<span class="def-item-dt-sep"></span></dt><dd>MR perfusion<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">THRIVE<span class="def-item-dt-sep"></span></dt><dd>Totaled Health Risks in Vascular Events</dd></dl>
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