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Research ArticleBrain

Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke

S. Prabhakaran, M. Soltanolkotabi, A.R. Honarmand, R.A. Bernstein, V.H. Lee, J.J. Conners, F. Dehkordi-Vakil, A. Shaibani, M.C. Hurley and S.A. Ansari
American Journal of Neuroradiology July 2014, 35 (7) 1303-1308; DOI: https://doi.org/10.3174/ajnr.A3889
S. Prabhakaran
aFrom the Departments of Neurology (S.P., R.A.B.)
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M. Soltanolkotabi
bRadiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois
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A.R. Honarmand
bRadiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois
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R.A. Bernstein
aFrom the Departments of Neurology (S.P., R.A.B.)
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V.H. Lee
cDepartment of Neurology (V.H.L., J.J.C.), Rush University Medical Center, Chicago, Illinois
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J.J. Conners
cDepartment of Neurology (V.H.L., J.J.C.), Rush University Medical Center, Chicago, Illinois
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F. Dehkordi-Vakil
dDepartment of Economics and Decision Sciences (F.D.-V.), Western Illinois University, Macomb, Illinois.
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A. Shaibani
bRadiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois
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M.C. Hurley
bRadiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois
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S.A. Ansari
bRadiology (M.S., A.R.H., A.S., M.C.H., S.A.A.), Northwestern University, Chicago, Illinois
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Tables

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    Table 1:

    Univariable analysis of characteristics associated with perfusion imaging selection

    Perfusion Selection (n = 76)NCCT Selection (n = 138)P Value
    Age (yr)<.001
        Mean (SD)72.4 (14.1)64.4 (16.3)
    Male, No. (%)26 (34.2)61 (44.2).154
    Onset to arrival time (min).520
        Median (IQR)245 (123.5–300.0)241.5 (180.0–320.0)
    Initial NIHSS score.018
        Median (IQR)18 (13–20)19 (16–22)
    Initial THRIVE score.529
        Median (IQR)4 (3–5)4.5 (3–6)
    IV tPA prior to ERT, No. (%)31 (40.8)67 (48.6).275
    Location of occlusion, No. (%)<.001
        Middle cerebral artery68 (89.5)91 (65.9)
        Internal carotid artery8 (10.5)47 (34.1)
    Mode of IA therapy.028
        Lytic only3 (3.8)0
        Mechanical only44 (57.9)95 (68.8)
        Lytic + mechanical29 (38.2)43 (31.2)
    Onset-to-GP time in minutes.366
        Median (IQR)348 (225.75–399.75)309 (245.5–375.0)
    Symptomatic hemorrhage, No. (%)4 (5.3)17 (12.3).148
    TICI 2b/3 reperfusion, No. (%)46 (62.5)65 (47.1).036
    Year.215
        20074 (5.3)15 (10.9)
        20089 (11.8)22 (15.9)
        200918 (23.7)29 (21.0)
        201017 (22.4)35 (25.4)
        201115 (19.7)27 (19.6)
        201213 (17.1)10 (7.2)
    • Note:—IQR indicates interquartile range; IA, intra-arterial; GP, groin puncture.

    • View popup
    Table 2:

    Univariable analysis of characteristics associated with good outcome (mRS 0–2) at 3 months

    Good Outcome (n = 88)Poor Outcome (n = 126)P Value
    Age (yr).891
        Mean (SD)67.0 (15.6)67.4 (16.3)
    Male, No. (%)36 (40.5)51 (40.9).949
    Onset-to-arrival time in minutes.627
        Median (IQR)240 (139.0–304.5)250 (178.5–366.0)
    Initial NIHSS score.009
        Median (IQR)18 (12.25–21.0)19 (16–22)
    Initial THRIVE score.004
        Median (IQR)4 (3–5)5 (4–6)
    IV tPA prior to ERT, No. (%)49 (55.7)49 (38.9).015
    Location of occlusion, No. (%).607
        Middle cerebral artery67 (76.1)92 (73.0)
        Internal carotid artery21 (23.9)34 (27.0)
    Mode of ERT.488
        Lytic only2 (2.3)1 (0.8)
        Mechanical only54 (61.4)85 (67.5)
        Lytic + mechanical32 (44.4)40 (31.7)
    Onset to GP time in minutes.790
        Median (IQR)306.5 (240.0–385.0)315 (242.75–379.75)
    Symptomatic hemorrhage, No. (%)3 (3.4)18 (14.3).009
    TICI 2b/3 reperfusion, No. (%)64 (72.7)47 (37.9)<.001
    Year.147
        20077 (8.0)12 (9.5)
        200810 (11.4)21 (9.8)
        200921 (23.9)26 (20.6)
        201029 (33.0)23 (18.3)
        201113 (14.0)29 (23.0)
        20128 (9.1)15 (11.9)
    • Note:—IQR indicates interquartile range; GP, groin puncture.

    • View popup
    Table 3:

    Multivariable model for good outcome (mRS 0–2 at 3 months) with the following dependent variables: age, calendar year, initial NIHSS score, IV tPA use, selection mode, location of occlusion, mode of therapy, final TICI score, and symptomatic hemorrhagea

    Adjusted OR95% CIP Value
    Selection mode.010
        NCCT only (reference)––
        Perfusion imaging2.341.23–4.47
    Initial NIHSS score (per point)0.920.87–0.98.006
    IV tPA prior to IAT2.121.13–3.96.019
    TICI score<.001
        TICI <2b (reference)––
        TICI 2b or 34.262.27–8.03
    • Note:—IQR indicates interquartile range; IAT, intra-arterial therapy.

    • ↵a Hosmer-Lemeshow test for goodness of fit: P = .229.

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American Journal of Neuroradiology: 35 (7)
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S. Prabhakaran, M. Soltanolkotabi, A.R. Honarmand, R.A. Bernstein, V.H. Lee, J.J. Conners, F. Dehkordi-Vakil, A. Shaibani, M.C. Hurley, S.A. Ansari
Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke
American Journal of Neuroradiology Jul 2014, 35 (7) 1303-1308; DOI: 10.3174/ajnr.A3889

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Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke
S. Prabhakaran, M. Soltanolkotabi, A.R. Honarmand, R.A. Bernstein, V.H. Lee, J.J. Conners, F. Dehkordi-Vakil, A. Shaibani, M.C. Hurley, S.A. Ansari
American Journal of Neuroradiology Jul 2014, 35 (7) 1303-1308; DOI: 10.3174/ajnr.A3889
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