| Title: |
Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data |
| Authors: |
Campbell, Bruce C.V.; Majoie, Charles B.L.M.; Albers, Gregory W.; Menon, Bijoy K.; Yassi, Nawaf; Sharma, Gagan; van Zwam, Wim H.; van Oostenbrugge, Robert J.; Demchuk, Andrew M.; Guillemin, Francis; White, Philip; Dávalos, Antoni; van der Lugt, Aad; Butcher, Kenneth S.; Cherifi, Aboubaker; Marquering, Henk A.; Cloud, Geoffrey; Macho Fernández, Juan M.; Madigan, Jeremy; Oppenheim, Catherine; Donnan, Geoffrey A.; Roos, Yvo B.W.E.M.; Shankar, Jai; Lingsma, Hester; Bonafé, Alain; Raoult, Hélène; Hernández-Pérez, María; Bharatha, Aditya; Jahan, Reza; Jansen, Olav; Richard, Sébastien; Levy, Elad I.; Berkhemer, Olvert A.; Soudant, Marc; Aja, Lucia; Davis, Stephen M.; Krings, Timo; Tisserand, Marie; San Román, Luis; Tomasello, Alejandro; Beumer, Debbie; Brown, Scott; Liebeskind, David S.; Bracard, Serge; Muir, Keith W.; Dippel, Diederik W.J.; Goyal, Mayank; Saver, Jeffrey L.; Jovin, Tudor G.; Hill, Michael D.; Mitchell, Peter J. |
| Publisher Information: |
Elsevier |
| Publication Year: |
2019 |
| Collection: |
University of Glasgow: Enlighten - Publications |
| Description: |
Background: CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome. Methods: In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1, 2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 μm2/s. Critically hypoperfused tissue was estimated as the volume of tissue with a CTP time to maximum longer than 6 s. Mismatch volume (ie, the estimated penumbral volume) was calculated as critically hypoperfused tissue volume minus ischaemic core volume. The association of ischaemic core and penumbral volumes with 90-day mRS score was analysed with multivariable logistic regression (functional independence, defined as mRS score 0–2) and ordinal logistic regression (functional improvement by at least one mRS category) in all patients and in a subset of those with more than 50% endovascular reperfusion, adjusted for baseline prognostic variables. The meta-analysis was prospectively designed by the HERMES executive committee, but not registered. Findings: We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| Relation: |
https://eprints.gla.ac.uk/167334/1/167334.pdf; Campbell, B. C.V. et al. (2019) Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurology , 18(1), pp. 46-55. (doi:10.1016/S1474-4422(18)30314-4 ) (PMID:30413385) |
| Availability: |
https://eprints.gla.ac.uk/167334/; https://eprints.gla.ac.uk/167334/1/167334.pdf |
| Rights: |
cc_by_nc_nd_4 |
| Accession Number: |
edsbas.38F1ACE5 |
| Database: |
BASE |