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Reperfusion Beyond 6 Hours Reduces Infarct Probability in Moderately Ischemic Brain Tissue.

Publication ,  Journal Article
An, H; Ford, AL; Eldeniz, C; Chen, Y; Vo, KD; Zhu, H; Powers, WJ; Lin, W; Lee, J-M
Published in: Stroke
January 2016

BACKGROUND AND PURPOSE: We aimed to examine perfusion changes between 3 and 6 and 6 and 24 hours after stroke onset and their impact on tissue outcome. METHODS: Acute ischemic stroke patients underwent perfusion magnetic resonance imaging at 3, 6, and 24 hours after stroke onset and follow-up fluid-attenuated inversion recovery at 1 month to assess tissue fate. Mean transit time prolongation maps (MTTp=MTT-[median MTT of contralateral hemisphere]) were obtained at 3 (MTTp3 h), 6 (MTTp6 h), and 24 hours (MTTp24 h). Perfusion changes between 3 and 6 hours (ΔMTTp3_6) and 6 and 24 hours (ΔMTTp6_24) were calculated. A 2-step analysis was performed to evaluate the impact of ΔMTTp3_6 and ΔMTTp6_24 on tissue fate. First, a voxel-based multivariable logistic regression was performed for each individual patient with MTTp3 h, ΔMTTp3_6, and ΔMTT6_24 as independent variables and tissue fate as outcome. Second, Wilcoxon signed-rank tests on logistic regression coefficients were performed across patients to evaluate whether ΔMTTp3_6 and ΔMTT6_24 had significant impact on tissue fate for varying severities of baseline perfusion. RESULTS: Perfusion change was common during both time periods: 85% and 81% of patients had perfusion improvement during 3- to 6- and 6- and 24-hour time intervals, respectively. ΔMTT3_6 significantly influenced 1-month infarct probability across a wide range of baseline perfusion (MTTp 0-15 s). ΔMTT6_24 also impacted 1-month infarct probability, but its influence was restricted to tissue with milder baseline ischemia (MTTp 0-10 s). CONCLUSIONS: Brain tissue with mild to moderate ischemia can be salvaged by reperfusion even after 6 hours. Such tissue could be targeted for intervention beyond current treatment windows.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

January 2016

Volume

47

Issue

1

Start / End Page

99 / 105

Location

United States

Related Subject Headings

  • Time Factors
  • Stroke
  • Reperfusion
  • Prospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Magnetic Resonance Angiography
  • Humans
  • Cerebral Infarction
  • Brain Ischemia
 

Citation

APA
Chicago
ICMJE
MLA
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An, H., Ford, A. L., Eldeniz, C., Chen, Y., Vo, K. D., Zhu, H., … Lee, J.-M. (2016). Reperfusion Beyond 6 Hours Reduces Infarct Probability in Moderately Ischemic Brain Tissue. Stroke, 47(1), 99–105. https://doi.org/10.1161/STROKEAHA.115.010656
An, Hongyu, Andria L. Ford, Cihat Eldeniz, Yasheng Chen, Katie D. Vo, Hongtu Zhu, William J. Powers, Weili Lin, and Jin-Moo Lee. “Reperfusion Beyond 6 Hours Reduces Infarct Probability in Moderately Ischemic Brain Tissue.Stroke 47, no. 1 (January 2016): 99–105. https://doi.org/10.1161/STROKEAHA.115.010656.
An H, Ford AL, Eldeniz C, Chen Y, Vo KD, Zhu H, et al. Reperfusion Beyond 6 Hours Reduces Infarct Probability in Moderately Ischemic Brain Tissue. Stroke. 2016 Jan;47(1):99–105.
An, Hongyu, et al. “Reperfusion Beyond 6 Hours Reduces Infarct Probability in Moderately Ischemic Brain Tissue.Stroke, vol. 47, no. 1, Jan. 2016, pp. 99–105. Pubmed, doi:10.1161/STROKEAHA.115.010656.
An H, Ford AL, Eldeniz C, Chen Y, Vo KD, Zhu H, Powers WJ, Lin W, Lee J-M. Reperfusion Beyond 6 Hours Reduces Infarct Probability in Moderately Ischemic Brain Tissue. Stroke. 2016 Jan;47(1):99–105.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

January 2016

Volume

47

Issue

1

Start / End Page

99 / 105

Location

United States

Related Subject Headings

  • Time Factors
  • Stroke
  • Reperfusion
  • Prospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Magnetic Resonance Angiography
  • Humans
  • Cerebral Infarction
  • Brain Ischemia