Volume 79, Issue 1 p. 76-89
Research Article

Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME

Gregory W. Albers MD

Corresponding Author

Gregory W. Albers MD

Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA

Address correspondence to Dr Albers, 780 Welch Road, Suite 350, Palo Alto, CA 94304. E-mail: [email protected]Search for more papers by this author
Mayank Goyal MD

Mayank Goyal MD

Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada

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Reza Jahan MD

Reza Jahan MD

Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, CA

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Alain Bonafe MD

Alain Bonafe MD

Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France

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Hans-Christoph Diener MD

Hans-Christoph Diener MD

Department of Neurology, Duisburg-Essen University Hospital, Essen, Germany

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Elad I. Levy MD, MBA

Elad I. Levy MD, MBA

Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY

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Vitor M. Pereira MD

Vitor M. Pereira MD

Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

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Christophe Cognard MD

Christophe Cognard MD

Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France

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David J. Cohen MD

David J. Cohen MD

Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO

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Werner Hacke MD

Werner Hacke MD

Department of Neurology, University of Heidelberg, Heidelberg, Germany

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Olav Jansen MD

Olav Jansen MD

Department of Radiology and Neuroradiology, Christian Albrechts University of Kiel, Kiel, Germany

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Tudor G. Jovin MD

Tudor G. Jovin MD

Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA

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Heinrich P. Mattle MD

Heinrich P. Mattle MD

Department of Neurology, Inselspital, University of Bern, Bern, Switzerland

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Raul G. Nogueira MD

Raul G. Nogueira MD

Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA

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Adnan H. Siddiqui MD

Adnan H. Siddiqui MD

Department of Neurosurgery, Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY

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Dileep R. Yavagal MD

Dileep R. Yavagal MD

Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL

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Blaise W. Baxter MD

Blaise W. Baxter MD

Department of Radiology, Erlanger Hospital at University of Tennessee, Chattanooga, TN

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Thomas G. Devlin MD

Thomas G. Devlin MD

Division of Neurology, Erlanger Hospital at University of Tennessee, Chattanooga, TN

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Demetrius K. Lopes MD

Demetrius K. Lopes MD

Department of Neurosurgery, Rush University Medical Center, Chicago, IL

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Vivek K. Reddy MD

Vivek K. Reddy MD

Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA

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Richard du Mesnil de Rochemont MD

Richard du Mesnil de Rochemont MD

Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany

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Oliver C. Singer MD

Oliver C. Singer MD

Department of Neurology, Goethe University Hospital, Frankfurt, Germany

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Roland Bammer PhD

Roland Bammer PhD

Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA

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Jeffrey L. Saver MD

Jeffrey L. Saver MD

Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA

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First published: 17 October 2015
Citations: 144

Abstract

Objective

Within the context of a prospective randomized trial (SWIFT PRIME), we assessed whether early imaging of stroke patients, primarily with computed tomography (CT) perfusion, can estimate the size of the irreversibly injured ischemic core and the volume of critically hypoperfused tissue. We also evaluated the accuracy of ischemic core and hypoperfusion volumes for predicting infarct volume in patients with the target mismatch profile.

Methods

Baseline ischemic core and hypoperfusion volumes were assessed prior to randomized treatment with intravenous (IV) tissue plasminogen activator (tPA) alone versus IV tPA + endovascular therapy (Solitaire stent-retriever) using RAPID automated postprocessing software. Reperfusion was assessed with angiographic Thrombolysis in Cerebral Infarction scores at the end of the procedure (endovascular group) and Tmax > 6-second volumes at 27 hours (both groups). Infarct volume was assessed at 27 hours on noncontrast CT or magnetic resonance imaging (MRI).

Results

A total of 151 patients with baseline imaging with CT perfusion (79%) or multimodal MRI (21%) were included. The median baseline ischemic core volume was 6ml (interquartile range = 0–16). Ischemic core volumes correlated with 27-hour infarct volumes in patients who achieved reperfusion (r = 0.58, p < 0.0001). In patients who did not reperfuse (<10% reperfusion), baseline Tmax > 6-second lesion volumes correlated with 27-hour infarct volume (r = 0.78, p = 0.005). In target mismatch patients, the union of baseline core and early follow-up Tmax > 6-second volume (ie, predicted infarct volume) correlated with the 27-hour infarct volume (r = 0.73, p < 0.0001); the median absolute difference between the observed and predicted volume was 13ml.

Interpretation

Ischemic core and hypoperfusion volumes, obtained primarily from CT perfusion scans, predict 27-hour infarct volume in acute stroke patients who were treated with reperfusion therapies. ANN NEUROL 2016;79:76–89

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