Evaluation of clinical-diffusion mismatch in intra-arterial thrombolysis treatment for acute middle cerebral artery occlusion

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Objective To evaluate the function of clinical-diffusion mismatch (CDM) in intraarterial thrombolysis treatment for acute middle cerebral artery occlusion (MCAO) and to evaluate specialty of CDM in predicting the putative penumbra.Methods All 106 acute MCAO patients within 6 hours after onset and examined by magnetic resonance angiography (MRA) were assigned into two groups:the intraartery thrombolysis group (n =36) and without thrombolysis group ( n =70).Both groups were subdivided into CDM sub-group and non-CDM sub-group based on the criteria of CDM:National Institutes of Health Stroke Scale (NIHSS) score ≥8 and ischemic volume on DWI ≤25 ml upon admission.NIHSS scores at the day 30 and 3 month after onset,and infarct volumes on T2 weighted imaging (T2 WI)at day 14 after onset were analyzed and compared between each sub-groups.Results The NIHSS scores in the CDM sub-group at both day 30 and the 3 month were significantly lower than the scores in the non-CDM sub-group among the patients having thrombolysis(3.20 ± 2.40 vs 6.76 ± 4.00,t =- 3.330,P =0.002 ; 2.20 ± 1.70 vs 6.05 ± 4.06,t =3.895,P =0.001 ),but not among the non-thrombolysis patients (5.22 ± 2.95 vs 5.66 ± 3.21,t =- 1.756,P =0.084 ;4.34 ± 2.53 vs 5.34 ± 3.42,t =1.234,P =0.353 ).Among the patients having CDM,the thrombolysis group resulted significant lower NIHSS scores at both day 30 and 3 month follow-up than non-thrombolysis group did (3.20 ±2.40 vs 5.22 ±2.95,t =- 2.210,P =0.034;2.20 ± 1.70 vs 4.34 ± 2.53,t =-3.128,P =0.003 ).However,among the patients of non-CDM,there was no difference in the NIHSS score between the thrombolysis group and the non-thrombolysis group at day 30 and 3 month (6.76±4.00 vs 5.66±3.21,t=1.209,P=0.231;6.05 ± 4.06 vs 5.34 ± 3.42,t =1.234,P=0.460).Among the CDM patients,the T2 WI infarct volume in the thrombolysis group was significantly smaller than that in the non-thrombolysis at day 14 onset ( ( 6.29 ± 4.41 ) ml vs ( 60.25 ± 49.23 ) ml,Z =- 4.848,P =0.001 ).Conclusion CDM may predict the putative penumbra with high specificity and can be applied in the therapy of intra-artery thrombolytic for acute MCAO patients. Key words: Diffusion magnetic resonance imaging; Infarction, middle cerebral artery; Thrombolytic therapy