• Maarten G Lansberg, Carlo W Cereda, Michael Mlynash, Nishant K Mishra, Manabu Inoue, Stephanie Kemp, Søren Christensen, Matus Straka, Greg Zaharchuk, Michael P Marks, Roland Bammer, Gregory W Albers, and Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) Study Investigators.
• From the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland. lansberg@stanford.edu.
• Neurology. 2015 Aug 25;85(8):708-14.

ObjectiveTo evaluate whether time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on MRI.MethodsPatients from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) cohort study with a perfusion-diffusion target mismatch were included. Reperfusion was defined as a decrease in the perfusion lesion volume of at least 50% between baseline and early follow-up. Good functional outcome was defined as a modified Rankin Scale score ≤2 at day 90. Lesion growth was defined as the difference between the baseline and the early follow-up diffusion-weighted imaging lesion volumes.ResultsAmong 78 patients with the target mismatch profile (mean age 66 ± 16 years, 54% women), reperfusion was associated with increased odds of good functional outcome (adjusted odds ratio 3.7, 95% confidence interval 1.2-12, p = 0.03) and attenuation of lesion growth (p = 0.02). Time to treatment did not modify these effects (p value for the time × reperfusion interaction is 0.6 for good functional outcome and 0.3 for lesion growth). Similarly, in the subgroup of patients with reperfusion (n = 46), time to treatment was not associated with good functional outcome (p = 0.2).ConclusionThe association between endovascular reperfusion and improved functional and radiologic outcomes is not time-dependent in patients with a perfusion-diffusion mismatch. Proof that patients with mismatch benefit from endovascular therapy in the late time window should come from a randomized placebo-controlled trial.© 2015 American Academy of Neurology.

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