Published in

American Heart Association, Stroke, 1(51), p. 209-215, 2020

DOI: 10.1161/strokeaha.119.027390

Links

Tools

Export citation

Search in Google Scholar

Quantitative Signal Intensity in Fluid-Attenuated Inversion Recovery and Treatment Effect in the WAKE-UP Trial

Journal article published in 2020 by Maria del Mar Castellanos Rodrigo, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators and administrative staff are as follows:]Wollboldt C. [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators and administrative staff are as follows:]van Sloten I. [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Golsari A. [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Alegiani A. [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Beck C. [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Choe Cu [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Voget D. [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Hoppe J. [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Schröder J. [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Rozanski M. [Wake, Isabelle van Sloten, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Nave Ah [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Göhler J. [Wake, UP (Efficacy and Safety of Mri Based Thrombolysis inWake Up Stroke Trial) investigators administrative staff are as follows:]Herm J. [Wake and other authors.
This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

Full text: Unavailable

Green circle
Preprint: archiving allowed
Orange circle
Postprint: archiving restricted
Red circle
Published version: archiving forbidden
Data provided by SHERPA/RoMEO

Abstract

Background and Purpose— Relative signal intensity of acute ischemic stroke lesions in fluid-attenuated inversion recovery (fluid-attenuated inversion recovery relative signal intensity [FLAIR-rSI]) magnetic resonance imaging is associated with time elapsed since stroke onset with higher intensities signifying longer time intervals. In the randomized controlled WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke Trial), intravenous alteplase was effective in patients with unknown onset stroke selected by visual assessment of diffusion weighted imaging fluid-attenuated inversion recovery mismatch, that is, in those with no marked fluid-attenuated inversion recovery hyperintensity in the region of the acute diffusion weighted imaging lesion. In this post hoc analysis, we investigated whether quantitatively measured FLAIR-rSI modifies treatment effect of intravenous alteplase. Methods— FLAIR-rSI of stroke lesions was measured relative to signal intensity in a mirrored region in the contralesional hemisphere. The relationship between FLAIR-rSI and treatment effect on functional outcome assessed by the modified Rankin Scale (mRS) after 90 days was analyzed by binary logistic regression using different end points, that is, favorable outcome defined as mRS score of 0 to 1, independent outcome defined as mRS score of 0 to 2, ordinal analysis of mRS scores (shift analysis). All models were adjusted for National Institutes of Health Stroke Scale at symptom onset and stroke lesion volume. Results— FLAIR-rSI was successfully quantified in stroke lesions in 433 patients (86% of 503 patients included in WAKE-UP). Mean FLAIR-rSI was 1.06 (SD, 0.09). Interaction of FLAIR-rSI and treatment effect was not significant for mRS score of 0 to 1 ( P =0.169) and shift analysis ( P =0.086) but reached significance for mRS score of 0 to 2 ( P =0.004). We observed a smooth continuing trend of decreasing treatment effects in relation to clinical end points with increasing FLAIR-rSI. Conclusions— In patients in whom no marked parenchymal fluid-attenuated inversion recovery hyperintensity was detected by visual judgement in the WAKE-UP trial, higher FLAIR-rSI of diffusion weighted imaging lesions was associated with decreased treatment effects of intravenous thrombolysis. This parallels the known association of treatment effect and elapsing time of stroke onset.