Extent of FLAIR Hyperintense Vessels May Modify Treatment Effect of Thrombolysis: A Post hoc Analysis of the WAKE-UP Trial

Frontiers in Neurology

Ivana Galinovic¹  Keith W. Muir¹  Salvador Pedraza²  Matthias Endres⁶  Jens Fiehler⁷  Anke Wouters⁸  Christian Gerloff⁹  Götz Thomalla^1,10  Robin Lemmens^1,10  Norbert Nighoghossian^1,11  Claus Z. Siemonsen^1,12  Vincent Thijs^1,14  Anna Kufner^1,15  Anne Sophie Grosch^1,16  Jochen B. Fiebach^1,16  Florent Boutitie^1,17  Bastian Cheng^1,18  Alina Königsberg^1,18  Martin Ebinger^1,19 

[1] Disease Research, Flanders Institute for Biotechnology, Leuven, Belgium;Psychology, University of Glasgow, Glasgow, United Kingdom;0German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany;0Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia;1Department of Neurology, Austin Health, Heidelberg, VIC, Australia;1Excellence Cluster NeuroCure, Charite-Universitätsmedizin Berlin, Berlin, Germany;2Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;3Department of Neurology, University Hospitals Leuven, Leuven, Belgium;4Department of Neurosciences, Experimental Neurology, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium;;5Laboratory of Neurobiology, Center for Brain &;6Institute of Neuroscience &7Department of Stroke Medicine, Claude Bernard University Lyon 1, CREATIS National Center for Scientific Research Mixed Unit of Research 5220-National Institute of Health and Medical Research U1206, National Institute of Applied Sciences of Lyon, Lyon Civil Hospices, Lyon, France;8Department of Radiology, Girona Institute of Biomedical Research, Institute of Diagnostic Imaging, Dr. Josep Trueta Hospital, Girona, Spain;9Department of Neurology, Aarhus University Hospital, Aarhus, Denmark;Berlin Institute of Health (BIH), Berlin, Germany;Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany;Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France;Department of Neurology, Head and Neurocenter, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany;German Centre for Cardiovascular Research (DZHK), Berlin, Germany;Hospices Civils de Lyon, Service de Biostatistique, Lyon, France;Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany;Université Lyon 1, Villeurbanne, France;

关键词: ischemic stroke;    FLAIR hyperintensities;    thrombolysis;    wake-up stroke;    prognosis;    MRI;   

DOI  :  10.3389/fneur.2020.623881

来源: DOAJ

【 摘 要 】

Background and Aims: Fluid-attenuated inversion recovery (FLAIR) hyperintense vessels (FHVs) on MRI are a radiological marker of vessel occlusion and indirect sign of collateral circulation. However, the clinical relevance is uncertain. We explored whether the extent of FHVs is associated with outcome and how FHVs modify treatment effect of thrombolysis in a subgroup of patients with confirmed unilateral vessel occlusion from the randomized controlled WAKE-UP trial.Methods: One hundred sixty-five patients were analyzed. Two blinded raters independently assessed the presence and extent of FHVs (defined as the number of slices with visible FHV multiplied by FLAIR slice thickness). Patients were then separated into two groups to distinguish between few and extensive FHVs (dichotomization at the median <30 or ≥30).Results: Here, 85% of all patients (n = 140) and 95% of middle cerebral artery (MCA) occlusion patients (n = 127) showed FHVs at baseline. Between MCA occlusion patients with few and extensive FHVs, no differences were identified in relative lesion growth (p = 0.971) and short-term [follow-up National Institutes of Health Stroke Scale (NIHSS) score; p = 0.342] or long-term functional recovery [modified Rankin Scale (mRS) <2 at 90 days poststroke; p = 0.607]. In linear regression analysis, baseline extent of FHV (defined as a continuous variable) was highly associated with volume of hypoperfused tissue (β = 2.161; 95% CI 0.96–3.36; p = 0.001). In multivariable regression analysis adjusted for treatment group, stroke severity, lesion volume, occlusion site, and recanalization, FHV did not modify functional recovery. However, in patients with few FHVs, the odds for good functional outcome (mRS) were increased in recombinant tissue plasminogen activator (rtPA) patients compared to those who received placebo [odds ratio (OR) = 5.3; 95% CI 1.2–24.0], whereas no apparent benefit was observed in patients with extensive FHVs (OR = 1.1; 95% CI 0.3–3.8), p-value for interaction was 0.11.Conclusion: While the extent of FHVs on baseline did not alter the evolution of stroke in terms of lesion progression or functional recovery, it may modify treatment effect and should therefore be considered relevant additional information in those patients who are eligible for intravenous thrombolysis.Clinical Trial Registration: Main trial (WAKE-UP): ClinicalTrials.gov, NCT01525290; and EudraCT, 2011-005906-32. Registered February 2, 2012.

【 授权许可】

Unknown