Quantification of Penumbral Volume in Association With Time From Stroke Onset in Acute Ischemic Stroke With Large Vessel Occlusion
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Published:2023-05-01
Issue:5
Volume:80
Page:523
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ISSN:2168-6149
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Container-title:JAMA Neurology
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language:en
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Short-container-title:JAMA Neurol
Author:
Seners Pierre123, Yuen Nicole1, Mlynash Michael1, Snyder Sarah J.4, Heit Jeremy J.4, Lansberg Maarten G.1, Christensen Soren1, Albucher Jean-François5, Cognard Christophe6, Sibon Igor7, Obadia Michael2, Savatovsky Julien8, Baron Jean-Claude39, Olivot Jean-Marc5, Albers Gregory W.1, Guenego Adrien10, Thalamas Claire10, Rousseau Vanessa10, Drif Amel10, Sommet Agnes10, Viguier Alain10, Darcourt Jean10, Calvière Lionel10, Menegon Patrice10, Raposo Nicolas10, Januel Anne-Christine10, Bonneville Fabrice10, Tourdias Thomas10, Mazighi Mikael10, Chollet François10, Barbieux Marianne10, Michelozzi Caterina10, Tall Philippe10, Caparros François10, Pouzet Brigitte10, Calvas Fabienne10, Galitzki Monique10, Renou Pauline10, Rouanet François10, Berge Jerome10, Marnat Gaultier10, Lucas Ludovic10, Coignon Cyrielle10, Sagnier Sharmila10, Debruxelle Sabrina10, Ledure Sylvain10,
Affiliation:
1. Stanford Stroke Center, Palo Alto, California 2. Neurology Department, Hôpital Fondation A. de Rothschild, Paris, France 3. Institut de Psychiatrie et Neurosciences de Paris, U1266, Inserm, Paris, France 4. Radiology Department, Stanford University, Palo Alto, California 5. Acute Stroke Unit, Hôpital Pierre-Paul Riquet, CHU Toulouse and Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, Toulouse, France 6. Neuroradiology Department, Toulouse University Hospital, Toulouse, France 7. Stroke Unit, Bordeaux University Hospital, Bordeaux, France 8. Radiology Department, Hôpital Fondation A. de Rothschild, Paris, France 9. Neurology Department, GHU Paris Psychiatrie et Neurosciences, Paris, France 10. for the Mismatch Prevalence Investigators
Abstract
ImportanceThe benefit of reperfusion therapies for acute ischemic stroke decreases over time. This decreasing benefit is presumably due to the disappearance of salvageable ischemic brain tissue (ie, the penumbra).ObjectiveTo study the association between stroke onset-to-imaging time and penumbral volume in patients with acute ischemic stroke with a large vessel occlusion.Design, Setting, and ParticipantsA retrospective, multicenter, cross-sectional study was conducted from January 1, 2015, to June 30, 2022. To limit selection bias, patients were selected from (1) the prospective registries of 2 comprehensive centers with systematic use of magnetic resonance imaging (MRI) with perfusion, including both thrombectomy-treated and untreated patients, and (2) 1 prospective thrombectomy study in which MRI with perfusion was acquired per protocol but treatment decisions were made with clinicians blinded to the results. Consecutive patients with acute stroke with intracranial internal carotid artery or first segment of middle cerebral artery occlusion and adequate quality MRI, including perfusion, performed within 24 hours from known symptoms onset were included in the analysis.ExposuresTime from stroke symptom onset to baseline MRI.Main Outcomes and MeasuresPenumbral volume, measured using automated software, was defined as the volume of tissue with critical hypoperfusion (time to maximum >6 seconds) minus the volume of the ischemic core. Substantial penumbra was defined as greater than or equal to 15 mL and a mismatch ratio (time to maximum >6-second volume/core volume) greater than or equal to 1.8.ResultsOf 940 patients screened, 516 were excluded (no MRI, n = 19; no perfusion imaging, n = 59; technically inadequate perfusion imaging, n = 75; second segment of the middle cerebral artery occlusion, n = 156; unwitnessed stroke onset, n = 207). Of 424 included patients, 226 (53.3%) were men, and mean (SD) age was 68.9 (15.1) years. Median onset-to-imaging time was 3.8 (IQR, 2.4-5.5) hours. Only 16 patients were admitted beyond 10 hours from symptom onset. Median core volume was 24 (IQR, 8-76) mL and median penumbral volume was 58 (IQR, 29-91) mL. An increment in onset-to-imaging time by 1 hour resulted in a decrease of 3.1 mL of penumbral volume (β coefficient = −3.1; 95% CI, −4.6 to −1.5; P < .001) and an increase of 3.0 mL of core volume (β coefficient = 3.0; 95% CI, 1.3-4.7; P < .001) after adjustment for confounders. The presence of a substantial penumbra ranged from approximately 80% in patients imaged at 1 hour to 70% at 5 hours, 60% at 10 hours, and 40% at 15 hours.Conclusions and RelevanceTime is associated with increasing core and decreasing penumbral volumes. Despite this, a substantial percentage of patients have notable penumbra in extended time windows; the findings of this study suggest that a large proportion of patients with large vessel occlusion may benefit from therapeutic interventions.
Publisher
American Medical Association (AMA)
Subject
Neurology (clinical)
Cited by
5 articles.
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