dc.contributor.author |
Parsons, M |
en |
dc.contributor.author |
Christensen, S |
en |
dc.contributor.author |
McElduff, P |
en |
dc.contributor.author |
Levi, CR |
en |
dc.contributor.author |
Butcher, K |
en |
dc.contributor.author |
De Silva, DA |
en |
dc.contributor.author |
Ebinger, M |
en |
dc.contributor.author |
Barber, Peter |
en |
dc.contributor.author |
Bladin, CF |
en |
dc.contributor.author |
Donnan, GA |
en |
dc.contributor.author |
Davis, SM |
en |
dc.contributor.author |
Investigators, for the EPITHET |
en |
dc.date.accessioned |
2012-03-08T19:06:17Z |
en |
dc.date.issued |
2010 |
en |
dc.identifier.citation |
Journal of Cerebral Blood Flow and Metabolism 30(6):1214-1225 2010 |
en |
dc.identifier.issn |
0271-678X |
en |
dc.identifier.uri |
http://hdl.handle.net/2292/13477 |
en |
dc.description.abstract |
We hypothesized that pretreatment magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) lesion volumes may have influenced clinical response to thrombolysis in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). In 98 patients randomized to intravenous (IV) tissue plasminogen activator (tPA) or placebo 3 to 6 h after stroke onset, we examined increasing acute DWI and PWI lesion volumes (Tmax—with 2-sec delay increments), and increasing PWI/DWI mismatch ratios, on the odds of both excellent (modified Rankin Scale (mRS): 0 to 1) and poor (mRS: 5 to 6) clinical outcome. Patients with very large PWI lesions (most had internal carotid artery occlusion) had increased odds ratio (OR) of poor outcome with IV-tPA (58% versus 25% placebo; OR=4.13, P=0.032 for Tmax +2-sec volume >190 mL). Excellent outcome from tPA treatment was substantially increased in patients with DWI lesions <18 mL (77% versus 18% placebo, OR=15.0, P<0.001). Benefit from tPA was also seen with DWI lesions up to 25 mL (69% versus 29% placebo, OR=5.5, P=0.03), but not for DWI lesions >25 mL. In contrast, increasing mismatch ratios did not influence the odds of excellent outcome with tPA. Clinical responsiveness to IV-tPA, and stroke outcome, depends more on baseline DWI and PWI lesion volumes than the extent of perfusion–diffusion mismatch. |
en |
dc.publisher |
2010 ISCBFM |
en |
dc.relation.ispartofseries |
Journal of Cerebral Blood Flow and Metabolism |
en |
dc.rights |
Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from http://www.sherpa.ac.uk/romeo/issn/0271-678X/ |
en |
dc.rights.uri |
https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm |
en |
dc.title |
Pre-treatment diffusion- and perfusion-MR lesion volumes have a crucial influence on clinical response to stroke thrombolysis |
en |
dc.type |
Journal Article |
en |
dc.identifier.doi |
10.1038/jcbfm.2010.3 |
en |
pubs.issue |
6 |
en |
pubs.begin-page |
1214 |
en |
pubs.volume |
30 |
en |
dc.rights.holder |
Copyright: 2010 ISCBFM |
en |
dc.identifier.pmid |
20087363 |
en |
pubs.end-page |
1225 |
en |
dc.rights.accessrights |
http://purl.org/eprint/accessRights/RestrictedAccess |
en |
pubs.subtype |
Article |
en |
pubs.elements-id |
100117 |
en |
pubs.org-id |
Medical and Health Sciences |
en |
pubs.org-id |
School of Medicine |
en |
pubs.org-id |
Medicine Department |
en |
pubs.record-created-at-source-date |
2010-09-01 |
en |
pubs.dimensions-id |
20087363 |
en |