期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 8, 期 22, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.119.012558
关键词
large-vessel occlusion; malignant profile; stroke
资金
- Japan Agency for Medical Research and Development [JP18ek0210109]
- Japan Society for the Promotion of Science [JP 17K00426]
- Bayer Scholarship for Cardiovascular Research 2018
Background-Malignant profiles were identified by imaging profiles and unfavorable outcomes that have poor response to reperfusion therapy. Many trials have used this profile in their inclusion criteria including large-vessel occlusion acute ischemic stroke trials. We aimed to redefine the cutoff values for malignant profile in acute ischemic stroke patients with large-vessel occlusion regardless of reperfusion therapy. Methods and Results-Consecutive acute ischemic stroke patients with anterior large-vessel occlusion were prospectively extracted from the National Cerebral and Cardiovascular Center Stroke Registry between March 2014 and December 2017. Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) and diffusion-weighted imaging lesion ischemic core volume (Vol(DWI)) were measured in acute ischemic stroke patients with large-vessel occlusion with or without treatment. Unfavorable outcome was defined as a modified Rankin Scale score 5 to 6 at 3 months, and optimal DWI-ASPECTS and VolDWI for unfavorable outcome were assessed. In total, 198 patients (111 men, 77 +/- 13 years old) were enrolled. Median DWI-ASPECTS was 7 (5-9), and median VolDWI was 55 (6-134) mL. Among the patients, 72 (36%) patients underwent reperfusion therapy, and 83 (42%) had unfavorable outcomes. The threshold values for a malignant profile on receiver operating characteristic curve analysis for DWI-ASPECTS and Vol(DWI) were 4 (area under the curve 0.78, P<0.01; sensitivity 0.71, specificity 0.75) and 71 mL (area under the curve 0.80, P<0.01; sensitivity 0.76, specificity 0.77), respectively. Conclusions-The cutoff values for our redefined malignant profile were DWI-ASPECTS 4 and Vol(DWI) 71 mL with no selection bias for reperfusion therapy in the real-world clinical practice.
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