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Mismatch Profile Influences Outcome After Mechanical Thrombectomy
Jean-Marc Olivot1,2,3, Jean-François Albucher1,2,4, Adrien Guenego3
1Acute Stroke Unit (J.-M.O., J.-F.A., A.V., L.C., N.R.), Centre Hospitalier Universitaire de Toulouse, France.
Stroke
|December 22, 2020
Summary
Baseline perfusion imaging profiles predict clinical response to mechanical thrombectomy (MT) for acute ischemic stroke. Identifying target mismatch (TMM) or mismatch (MM) profiles improves prediction of functional recovery after successful reperfusion.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- Mechanical thrombectomy (MT) is standard for acute ischemic stroke from large vessel occlusion.
- Clinical outcomes after MT vary, even with high reperfusion rates.
- Optimal imaging selection criteria for early treatment windows are lacking.
Purpose of the Study:
- To investigate if baseline perfusion imaging profiles can predict clinical response to MT.
- To evaluate the association between perfusion imaging profiles and functional recovery.
Main Methods:
- Prospective multicenter cohort study of 218 patients undergoing MT within 6 hours.
- Patients categorized into target mismatch (TMM), mismatch (MM), or no mismatch groups based on perfusion imaging.
- Functional recovery (modified Rankin Scale 0-2) at 3 months assessed blinded to imaging results.
Main Results:
- 54% overall functional recovery rate.
- TMM and MM profiles were independently associated with higher functional recovery rates (aOR 3.3 and 5.9, respectively).
- Reperfusion (86% achieved) was more frequent in TMM and MM patients and associated with better outcomes.
Conclusions:
- Approximately 80% of patients showed penumbra on perfusion imaging.
- Perfusion imaging profiles effectively predict clinical response to MT for acute ischemic stroke.
- Imaging selection based on perfusion may optimize MT outcomes.
