Abstract
BackgroundClinical-Diffusion mismatch (CDM; NIHSS score ≥8 & DWI lesion volume ≤25 mL) and Perfusion-Diffusion mismatch (PDM; difference >20% between initial DWI and MTT lesion volumes) have been proposed as surrogates for ischemic brains that are at risk of infarction. However, their utility to improve the selection of patients for thrombolytic treatment remains controversial. Our aim was to identify molecular biomarkers that can be used with neuroimaging to facilitate the selection of ischemic stroke patients for systemic thrombolysis.MethodsWe prospectively studied 595 patients with ischemic stroke within 12 h of the stroke onset. A total of 184 patients received thrombolytic treatment according to the SITS-MOST criteria. DWI and MTT volumes were measured at admission. The main outcome variable was good functional outcome at 3 months (modified Rankin scale <3). Serum levels of glutamate (Glu), IL-10, TNF-α, IL-6, NSE, and active MMP-9 also were determined at admission.ResultsPatients treated with t-PA who presented with PDM had higher IL-10 levels at admission (p < 0.0001). In contrast, patients with CDM had higher levels of IL-10 (p < 0.0001) as well as Glu and TNF-α (all p < 0.05) and lower levels of NSE and active MMP-9 (all p < 0.0001). IL-10 ≥ 30 pg/mL predicts good functional outcome at 3 months with a specificity of 88% and a sensitibity of 86%. IL-10 levels ≥30 pg/mL independently in both patients with PDM (OR, 18.9) and CDM (OR, 7.5), after an adjustment for covariates.ConclusionsSerum levels of IL-10 facilitate the selection of ischemic stroke patients with CDM and PDM for systemic thrombolysis.
Highlights
Clinical-Diffusion mismatch (CDM; National Institute of Health Stroke Scale (NIHSS) score ≥8 & DWI lesion volume ≤25 mL) and PerfusionDiffusion mismatch (PDM; difference >20% between initial DWI and mean transient time (MTT) lesion volumes) have been proposed as surrogates for ischemic brains that are at risk of infarction
Patients who presented with stroke on awakening (n = 38), severe systemic disease (n = 27), dementia (n = 9), lesions located within the vertebrobasilar territory (n = 13), psychiatric disease (n = 9), chronic inflammatory disease (n = 21), or active infection (n = 11), or were enrolled in other clinical trials (n = 55), refused to participate in the study (n = 4), had technical problems with the magnetic resonance imaging (MRI) (n = 9), were lost to follow-up (n = 36) or were undergoing other recanalization procedures (n = 8) were excluded from the study
All patients had DWI-MRI performed at admission, and 237 patients (39.8%) had PWI-MRI performed at admission
Summary
Clinical-Diffusion mismatch (CDM; NIHSS score ≥8 & DWI lesion volume ≤25 mL) and PerfusionDiffusion mismatch (PDM; difference >20% between initial DWI and MTT lesion volumes) have been proposed as surrogates for ischemic brains that are at risk of infarction. Their utility to improve the selection of patients for thrombolytic treatment remains controversial. Our aim was to identify molecular biomarkers that can be used with neuroimaging to facilitate the selection of ischemic stroke patients for systemic thrombolysis. The usefulness of CDM to improve the selection of patients for thrombolytic treatment has not been confirmed
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