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Abstract
Objective: We explored the relationship between the site of vascular occlusion and the response to endovascular treatment in patients with acute ischemic stroke and also considered the impact of mismatch profile.
Methods: DEFUSE-2 was a prospective cohort study of patients treated with endovascular therapy. Patients with internal carotid artery (ICA) and middle cerebral artery (MCA) involvement were included in this substudy. Mismatch and reperfusion status was assessed on MRI. Favorable clinical response was defined as an improvement of at least 8 points on the NIH Stroke Scale.
Results: Reperfusion rates were comparable in both groups (61% for ICA and 59% for MCA). In the setting of reperfusion, percentages of favorable clinical response were similar between patients with stroke due to ICA (65%) and MCA (63%) occlusions. When reperfusion was not achieved, favorable outcomes were less frequent with obstructions of the ICA (9%) than the MCA (52%). Among target mismatch patients, the adjusted odds ratio for favorable clinical response associated with reperfusion was 39.7 (95% confidence interval 1.4–1,132.8) for ICA occlusions vs 5.1 (95% confidence interval 1.4–19.3) for MCA occlusions.
Conclusions: Endovascular reperfusion is associated with favorable clinical response regardless of the location of the arterial occlusion. This association is strongest for target mismatch patients with ICA occlusions. Target mismatch patients with either ICA or MCA occlusions appear to be good candidates for endovascular reperfusion therapy.
GLOSSARY
- CI=
- confidence interval;
- DEFUSE-2=
- Diffusion Weighted Imaging Evaluation for Understanding Stroke Evolution–2;
- DWI=
- diffusion-weighted imaging;
- ICA=
- internal carotid artery;
- MCA=
- middle cerebral artery;
- MERCI=
- Mechanical Embolus Removal in Cerebral Ischemia;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- PWI=
- perfusion-weighted imaging
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 608
- Received December 27, 2012.
- Accepted in final form April 10, 2013.
- © 2013 American Academy of Neurology
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