Impact of MRI Selection on Triage of Endovascular Therapy in Acute Ischemic Stroke: The MRI in Acute Management of Ischemic Stroke (MIAMIS) Registry.

Q1 Medicine
Interventional Neurology Pub Date : 2020-01-01 Epub Date: 2019-03-15 DOI:10.1159/000490580
Kunakorn Atchaneeyasakul, Ty Shang, Diogo Haussen, Gustavo Ortiz, Dileep Yavagal
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引用次数: 7

Abstract

Background: The recently published multicenter randomized DAWN trial confirmed greater outcome benefit of endovascular therapy (ET) for anterior circulation large vessel occlusion ischemic stroke from 6 to 24 h from symptom onset compared to medical management in patients selected by advanced imaging with MRI or perfusion CT to identify mismatch between clinical deficit and infarct volume, which represents salvageable penumbra. The debate of CT over MRI is usually the potentially increase time consumption and the difficulty in establishing an adequate standardized workflow utilizing MRI during the hyperacute phase.

Purpose: While CT-based selection of patients is the current standard of care, we sought to determine the time impact of the alternative approach of MRI selection in the 0-12 h window.

Methods: In the MRI in Acute Management of Ischemic Stroke (MIAMIS) registry, we retrospectively analyzed 89 consecutive patients from January 2008 to January 2010 who presented with acute stroke symptoms with a National Institutes of Health Stroke Scale score ≥5 or aphasia within 0-12 h from symptom onset. The presence of penumbra was determined by MR perfusion-diffusion mismatch or clinical diffusion mismatch. Patients were stratified based on the presence of mismatch and clinical outcomes in patients who received ET. Imaging times were recorded.

Results: The MRI turnaround time was 95.5 ± 48.5 min. The total MRI time was 27.7 ± 12.8 min. Seventeen (19.1%) patients were found to have nonvascular etiology. Mismatch was found in 35 (48.6%) patients with acute ischemic stroke (AIS). Patients with nonvascular etiology were younger (55.7 vs. 65.6 years, p < 0.02), without any vessel occlusion or mismatch noticed in this group. We dichotomized the 39 AIS patients with vessel occlusion into two subgroups: these with mismatch and these without. Patients without mismatch were older (76.7 vs. 64.4 years, p < 0.05), more likely to have congestive heart failure (71.4 vs. 22%, p < 0.03), a higher total serum cholesterol level (196 vs. 156 mg/dL, p < 0.04), and medium to large lesions on diffusion-weighted imaging (DWI) (85.7 vs. 37.5%, p < 0.04).

Conclusions: Multimodality MRI screening for AIS symptoms for ET is feasible. Optimizing each center's protocol and the utilization of MRI with DWI only may be a time-saving alternative.

MRI选择对急性缺血性卒中血管内治疗分诊的影响:MRI在急性缺血性卒中管理(MIAMIS)登记。
背景:最近发表的多中心随机DAWN试验证实,在症状发作后6至24小时内,与医学治疗相比,血管内治疗(ET)对前循环大血管闭塞性脑卒中患者的疗效更大,这些患者通过MRI或灌注CT的高级成像来识别临床缺陷和梗死体积之间的不匹配,这代表了可挽救的半暗区。CT与MRI的争论通常是潜在的增加时间消耗和在超急性期利用MRI建立适当的标准化工作流程的困难。目的:虽然基于ct的患者选择是目前的标准护理,但我们试图确定在0-12小时窗口内MRI选择的替代方法的时间影响。方法:在缺血性脑卒中急性管理MRI (MIAMIS)登记中,我们回顾性分析了2008年1月至2010年1月连续89例出现急性脑卒中症状且美国国立卫生研究院卒中量表评分≥5分或在症状出现后0-12小时内出现失语的患者。通过MR灌注-扩散失配或临床弥散失配来判断半暗影的存在。根据不匹配的存在和接受ET的患者的临床结果对患者进行分层。记录成像时间。结果:MRI周转时间为95.5±48.5 min,总MRI时间为27.7±12.8 min。17例(19.1%)患者发现非血管病因。35例(48.6%)急性缺血性卒中(AIS)患者存在不匹配。非血管病因患者较年轻(55.7岁vs. 65.6岁,p < 0.02),本组未发现血管闭塞或不匹配。我们将39例血管闭塞的AIS患者分为两个亚组:不匹配组和不匹配组。没有配错的患者年龄较大(76.7比64.4岁,p < 0.05),更容易发生充血性心力衰竭(71.4比22%,p < 0.03),血清总胆固醇水平较高(196比156 mg/dL, p < 0.04),弥散加权成像(DWI)中大型病变(85.7比37.5%,p < 0.04)。结论:多模态MRI筛查AIS症状诊断ET是可行的。优化每个中心的方案和利用MRI与DWI可能是一个节省时间的选择。
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Interventional Neurology
Interventional Neurology CLINICAL NEUROLOGY-
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