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Bivard A, Churilov L, Ma H, et al. Does variability in automated perfusion software outputs for acute ischemic stroke matter? Reanalysis of EXTEND perfusion imaging. CNS Neurosci Ther. 2021;28(1):139-144doi: 10.1111/cns.13756.
Bivard, A., Churilov, L., Ma, H., Levi, C., Campbell, B., Yassi, N., Meretoja, A., Zhao, H., Sharma, G., Chen, C., Davis, S., Donnan, G., Yan, B., Parsons, M. (2022). Does variability in automated perfusion software outputs for acute ischemic stroke matter? Reanalysis of EXTEND perfusion imaging. CNS neuroscience & therapeutics, 28(1), 139-144. https://doi.org/10.1111/cns.13756
Bivard, Andrew, et al. "Does variability in automated perfusion software outputs for acute ischemic stroke matter? Reanalysis of EXTEND perfusion imaging." CNS neuroscience & therapeutics vol. 28,1 (2022): 139-144. doi: https://doi.org/10.1111/cns.13756
Bivard A, Churilov L, Ma H, Levi C, Campbell B, Yassi N, Meretoja A, Zhao H, Sharma G, Chen C, Davis S, Donnan G, Yan B, Parsons M. Does variability in automated perfusion software outputs for acute ischemic stroke matter? Reanalysis of EXTEND perfusion imaging. CNS Neurosci Ther. 2022 Jan;28(1):139-144. doi: 10.1111/cns.13756. Epub 2021 Nov 16. PMID: 34786868; PMCID: PMC8673699.
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CNS Neurosci Ther. 2022 Jan;28(1):139-144. doi: 10.1111/cns.13756. Epub 2021 Nov 16.

Does variability in automated perfusion software outputs for acute ischemic stroke matter? Reanalysis of EXTEND perfusion imaging.

CNS neuroscience & therapeutics

Andrew Bivard, Leonid Churilov, Henry Ma, Christopher Levi, Bruce Campbell, Nawaf Yassi, Atte Meretoja, Henry Zhao, Gagan Sharma, Chushuang Chen, Stephen Davis, Geoffrey Donnan, Bernard Yan, Mark Parsons,

Affiliations

  1. Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.
  2. Department of Medicine, School of Clinical Science, Monash University, Clayton, VIC, Australia.
  3. Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
  4. Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
  5. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
  6. Department of Neurology Liverpool Hospital, Ingham Institute of Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Liverpool, NSW, Australia.

PMID: 34786868 PMCID: PMC8673699 DOI: 10.1111/cns.13756

Abstract

AIMS: We reprocessed the Extending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND) perfusion imaging with a different automated software with the aim of comparing mismatch eligibility and outcomes.

METHODS: EXTEND baseline perfusion imaging data were reprocessed using autoMIStar software to identify patients who were eligible based on the same target mismatch criteria as per the original trial.

RESULTS: From the 225 patients fulfilling RAPID-based mismatch criteria randomized in the EXTEND study, 196 (87%) patients met the revised mismatch criteria. Most common reasons for not meeting revised criteria were core >70 ml (n = 9), and no perfusion lesion/lack of penumbral tissue (n = 20). The revised perfusion lesion volumes were significantly smaller compared to the original RAPID volumes (median 68 ml IQR 34-102 ml vs. 42 ml 16-92 ml, p = 0.036). Of the patients who met the revised mismatch criteria, 40% receiving alteplase had modified Rankin Scale (mRS) 0-1 at 3-month compared to 28% with placebo (Adjusted Odds Ratio (OR) = 2.23, CI 1.08-4.58, p = 0.028). In contrast, in the original mismatch cohort, 35% receiving alteplase had mRS 0-1 at 3-month compared to 30% with placebo (adjusted OR = 1.88, p = 0.056).

CONCLUSIONS: These data reinforce the benefit of alteplase in the later time window, and suggest that differences in automated perfusion imaging software outputs may be clinically relevant.

© 2021 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

Keywords: CT perfusion; ischemic stroke; target mismatch; thrombolysis

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