Abstract 2632: The Relationship Between MRI/PWI-Time Intensity Curve And 3-month Clinical Outcome Of The Acute Ischemic Patients Who Underwent Endovascular Reperfusion Therapy For IC Or MCA Occlusion.

Abstract

The purpose of our study was to investigate the relationship between MRI/PWI-Time Intensity curve (TIC) and 3-month clinical outcome following endovascular reperfusion therapy in acute ischemic stroke patients with occlusion of the internal carotid artery (ICA) or the middle cerebral artery (MCA). We retrospectively analyzed the acute stroke patients 1) who were admitted to our institution from 2004 to 2010, 2) with serious neurological symptoms, 3) who had total occlusion of the ICA or MCA displayed by MRA with DWI -PWI mismatch and 5) who underwent emergency endovascular reperfusion therapy within 8 hours from stroke onset. We investigated patient's baseline characteristics, emergency MRI findings , successful recanalization defined as TICI 2B or 3,and 3-month modified Rankin scale(3M-mRS). We evaluated PWI findings using TIC types. Region of interests were set at symmetrical positions of the bilateral MCA territories and time-intensity-curves (TICs) were calculated. The types of TICs were classified into four patterns according to the timeto peak (TP) and the reduction value of the peak signal (PV). Comparing the affected side with the contralateral side, we defined type 1 as TPa>TPc and PVaTPc and PVc/2≤PVa<PVc, type 3 as TPa >TPc and PVa≥PVc, and type 4 as TPa=TPc. We analyzed the relationship between the PWI/TIC and mRS at 3 months (3M-mRS) statistically. We defined favorable clinical outcome as 3M-mRS of 0-2, and assessed pre-treatment predictors for favorable clinical outcome and death within 3months by using logistic regression analysis. Seventy one patients were analyzed. Their median age was 75 years, median admission NIHSS was 17, median DWI-ASPECT score was 7, sixty three patients had cadiogenic stroke, successful recanalization was achieved in 38 patients (54.0%), and median 3M-mRS was 3. Twenty three patients (32%) had 3M-mRS of 0-2 and 11 patients (37%) died within 3 months. PWI-TICs of type 1,2,3 and 4 were in 13, 37, 21 and 0 patients, respectively. Type of PWI-TIC was significantly correlated to 3M-mRS (r=-0.24,P=0.047). The higher PWI/TIC type were, the lower 3M-mRS were. Logistic regression analysis demonstrated that independent predictors of favorable clinical outcome (3M-mRS of 0-2) were DWI ASPECTS and age, whereas, independent predictors of death within 3months from onset were type 1 of PWI-TIC (OR,5.71;95%CI,1.28-25.4, P=0.022) and admission NIHSS. Conclusion; In ischemic stroke patients who underwent endovascular reperfusion therapy for the ICA or MCA occlusion within 8hours from onset, type of PWI-TIC was the significant predictor for death within 3months from onset.