Contrast-Enhanced MR Perfusion Imaging - University of Wisconsin ...

DEFUSE Trial
Mismatch associated
with good outcomes following reperfusion
Before tPA
NIHSS 16
Albers et al Ann Neurol 60: 508-517, 517, 2006
Key Results of the DEFUSE Study
• Target Mismatch pattern (42%)
identifies patients who appear to benefit
substantially from early reperfusion
3 cc
65 cc ↓ M2 Flow
• Malignant MRI pattern (8%) predicts
severe ICH following reperfusion
4.5 hrs
After tPA
NIHSS 5
• Small DWI and PWI lesions (26%)
are associated with favorable outcomes
6 cc 0 cc Improved
Albers et al Ann Neurol 60: 508-517, 517, 2006
MR Rescue - Penumbral Pattern:
Recanalization, Good Outcome
Pre
Post
Baseline NIHSS 11 Left MCA Occlusion, TIMI 2
Recanalization at 5 hrs 50 mins, Day 90 mRS 1
MR RESCUE data courtesy of Chelsea Kidwell
EPITHET Results
• EPI Thrombolysis Evaluation Trial
• 101 patients, 3-6 hrs IV tPA vs placebo
• Selected by CT, but all got PWI/DWI
• MR at 3-5 days and 90 days
• Results (ISC 2008)
• 83% had penumbral pattern (Tmax >2 sec)
• Mean infarct growth: 1.24 tPA vs 1.78 placebo
• If mismatch present, tPA ↑ reperfusion
• All trends favor PWI-DWI selection
• EXTEND mismatch trial being planned: 3-9 hrs
Davis et al Lancet Neurology 2008; 7:299-309
PWI-DWI selection better than basic CT
Schellinger et al Stroke 2007; 38:2640-2645
1210 patients 5 centers IV tPA
CT