Clinical relevance and practical implications of trials of perfusion and angiographic imaging in patients with acute ischaemic stroke

a multicentre cohort imaging study

Joanna M. Wardlaw, Keith W Muir, Mary J. MacLeod, Christopher Weir, Ferghal McVerry, Trevor Carpenter, Kirsten Shuler, Ralph Thomas, Paul Acheampong, Krishna Dani, Alison Murray

Research output: Contribution to journalArticle

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Abstract

Background In randomised trials testing treatments for acute ischaemic stroke, imaging markers of tissue reperfusion and arterial recanalisation may provide early response indicators.

Objective To determine the predictive value of structural, perfusion and angiographic imaging for early and late clinical outcomes and assess practicalities in three comprehensive stroke centres.

Methods We recruited patients with potentially disabling stroke in three stroke centres, performed magnetic resonance (MR) or CT, including perfusion and angiography imaging, within 6 h, at 72 h and 1 month after stroke. We assessed the National Institutes of Health Stroke Scale (NIHSS) score serially and functional outcome at 3 months, tested associations between clinical variables and structural imaging, several perfusion parameters and angiography.

Results Among 83 patients, median age 71 (maximum 89), median NIHSS 7 (range 1–30), 38 (46%) received alteplase, 41 (49%) had died or were dependent at 3 months. Most baseline imaging was CT (76%); follow-up was MR (79%) despite both being available acutely. At presentation, perfusion lesion size varied considerably between parameters (p<0.0001); 40 (48%) had arterial occlusion. Arterial occlusion and baseline perfusion lesion extent were both associated with baseline NIHSS (p<0.0001). Recanalisation by 72 h was associated with 1 month NIHSS (p=0.0007) and 3 month functional outcome (p=0.048), whereas tissue reperfusion, using even the best perfusion parameter, was not (p=0.11, p=0.08, respectively).

Conclusion Early recanalisation on angiography appeared to predict clinical outcome more directly than did tissue reperfusion. Acute assessment with CT and follow-up with MR was practical and feasible, did not preclude image analysis, and would enhance trial recruitment and generalisability of results.

Original languageEnglish
Pages (from-to)1001-1007
Number of pages7
JournalJournal of Neurology, Neurosurgery & Psychiatry
Volume84
Issue number9
Early online date3 May 2013
DOIs
Publication statusPublished - Sep 2013

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Perfusion Imaging
Cohort Studies
Stroke
National Institutes of Health (U.S.)
Reperfusion
Angiography
Magnetic Resonance Spectroscopy
Perfusion
Tissue Plasminogen Activator

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Clinical relevance and practical implications of trials of perfusion and angiographic imaging in patients with acute ischaemic stroke : a multicentre cohort imaging study. / Wardlaw, Joanna M.; Muir, Keith W; MacLeod, Mary J.; Weir, Christopher ; McVerry, Ferghal; Carpenter, Trevor; Shuler, Kirsten; Thomas, Ralph ; Acheampong, Paul; Dani, Krishna ; Murray, Alison .

In: Journal of Neurology, Neurosurgery & Psychiatry, Vol. 84, No. 9, 09.2013, p. 1001-1007.

Research output: Contribution to journalArticle

Wardlaw, Joanna M. ; Muir, Keith W ; MacLeod, Mary J. ; Weir, Christopher ; McVerry, Ferghal ; Carpenter, Trevor ; Shuler, Kirsten ; Thomas, Ralph ; Acheampong, Paul ; Dani, Krishna ; Murray, Alison . / Clinical relevance and practical implications of trials of perfusion and angiographic imaging in patients with acute ischaemic stroke : a multicentre cohort imaging study. In: Journal of Neurology, Neurosurgery & Psychiatry. 2013 ; Vol. 84, No. 9. pp. 1001-1007.
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abstract = "Background In randomised trials testing treatments for acute ischaemic stroke, imaging markers of tissue reperfusion and arterial recanalisation may provide early response indicators.Objective To determine the predictive value of structural, perfusion and angiographic imaging for early and late clinical outcomes and assess practicalities in three comprehensive stroke centres.Methods We recruited patients with potentially disabling stroke in three stroke centres, performed magnetic resonance (MR) or CT, including perfusion and angiography imaging, within 6 h, at 72 h and 1 month after stroke. We assessed the National Institutes of Health Stroke Scale (NIHSS) score serially and functional outcome at 3 months, tested associations between clinical variables and structural imaging, several perfusion parameters and angiography.Results Among 83 patients, median age 71 (maximum 89), median NIHSS 7 (range 1–30), 38 (46{\%}) received alteplase, 41 (49{\%}) had died or were dependent at 3 months. Most baseline imaging was CT (76{\%}); follow-up was MR (79{\%}) despite both being available acutely. At presentation, perfusion lesion size varied considerably between parameters (p<0.0001); 40 (48{\%}) had arterial occlusion. Arterial occlusion and baseline perfusion lesion extent were both associated with baseline NIHSS (p<0.0001). Recanalisation by 72 h was associated with 1 month NIHSS (p=0.0007) and 3 month functional outcome (p=0.048), whereas tissue reperfusion, using even the best perfusion parameter, was not (p=0.11, p=0.08, respectively).Conclusion Early recanalisation on angiography appeared to predict clinical outcome more directly than did tissue reperfusion. Acute assessment with CT and follow-up with MR was practical and feasible, did not preclude image analysis, and would enhance trial recruitment and generalisability of results.",
author = "Wardlaw, {Joanna M.} and Muir, {Keith W} and MacLeod, {Mary J.} and Christopher Weir and Ferghal McVerry and Trevor Carpenter and Kirsten Shuler and Ralph Thomas and Paul Acheampong and Krishna Dani and Alison Murray",
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T1 - Clinical relevance and practical implications of trials of perfusion and angiographic imaging in patients with acute ischaemic stroke

T2 - a multicentre cohort imaging study

AU - Wardlaw, Joanna M.

AU - Muir, Keith W

AU - MacLeod, Mary J.

AU - Weir, Christopher

AU - McVerry, Ferghal

AU - Carpenter, Trevor

AU - Shuler, Kirsten

AU - Thomas, Ralph

AU - Acheampong, Paul

AU - Dani, Krishna

AU - Murray, Alison

PY - 2013/9

Y1 - 2013/9

N2 - Background In randomised trials testing treatments for acute ischaemic stroke, imaging markers of tissue reperfusion and arterial recanalisation may provide early response indicators.Objective To determine the predictive value of structural, perfusion and angiographic imaging for early and late clinical outcomes and assess practicalities in three comprehensive stroke centres.Methods We recruited patients with potentially disabling stroke in three stroke centres, performed magnetic resonance (MR) or CT, including perfusion and angiography imaging, within 6 h, at 72 h and 1 month after stroke. We assessed the National Institutes of Health Stroke Scale (NIHSS) score serially and functional outcome at 3 months, tested associations between clinical variables and structural imaging, several perfusion parameters and angiography.Results Among 83 patients, median age 71 (maximum 89), median NIHSS 7 (range 1–30), 38 (46%) received alteplase, 41 (49%) had died or were dependent at 3 months. Most baseline imaging was CT (76%); follow-up was MR (79%) despite both being available acutely. At presentation, perfusion lesion size varied considerably between parameters (p<0.0001); 40 (48%) had arterial occlusion. Arterial occlusion and baseline perfusion lesion extent were both associated with baseline NIHSS (p<0.0001). Recanalisation by 72 h was associated with 1 month NIHSS (p=0.0007) and 3 month functional outcome (p=0.048), whereas tissue reperfusion, using even the best perfusion parameter, was not (p=0.11, p=0.08, respectively).Conclusion Early recanalisation on angiography appeared to predict clinical outcome more directly than did tissue reperfusion. Acute assessment with CT and follow-up with MR was practical and feasible, did not preclude image analysis, and would enhance trial recruitment and generalisability of results.

AB - Background In randomised trials testing treatments for acute ischaemic stroke, imaging markers of tissue reperfusion and arterial recanalisation may provide early response indicators.Objective To determine the predictive value of structural, perfusion and angiographic imaging for early and late clinical outcomes and assess practicalities in three comprehensive stroke centres.Methods We recruited patients with potentially disabling stroke in three stroke centres, performed magnetic resonance (MR) or CT, including perfusion and angiography imaging, within 6 h, at 72 h and 1 month after stroke. We assessed the National Institutes of Health Stroke Scale (NIHSS) score serially and functional outcome at 3 months, tested associations between clinical variables and structural imaging, several perfusion parameters and angiography.Results Among 83 patients, median age 71 (maximum 89), median NIHSS 7 (range 1–30), 38 (46%) received alteplase, 41 (49%) had died or were dependent at 3 months. Most baseline imaging was CT (76%); follow-up was MR (79%) despite both being available acutely. At presentation, perfusion lesion size varied considerably between parameters (p<0.0001); 40 (48%) had arterial occlusion. Arterial occlusion and baseline perfusion lesion extent were both associated with baseline NIHSS (p<0.0001). Recanalisation by 72 h was associated with 1 month NIHSS (p=0.0007) and 3 month functional outcome (p=0.048), whereas tissue reperfusion, using even the best perfusion parameter, was not (p=0.11, p=0.08, respectively).Conclusion Early recanalisation on angiography appeared to predict clinical outcome more directly than did tissue reperfusion. Acute assessment with CT and follow-up with MR was practical and feasible, did not preclude image analysis, and would enhance trial recruitment and generalisability of results.

U2 - 10.1136/jnnp-2012-304807

DO - 10.1136/jnnp-2012-304807

M3 - Article

VL - 84

SP - 1001

EP - 1007

JO - Journal of Neurology, Neurosurgery & Psychiatry

JF - Journal of Neurology, Neurosurgery & Psychiatry

SN - 0022-3050

IS - 9

ER -