{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T14:06:34Z","timestamp":1792850794038,"version":"4.5.0"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2019,3]]},"abstract":"\n Background and Purpose\u2014<\/jats:title>\n Efficacy of endovascular thrombectomy has been demonstrated up to 24 hours after stroke onset in patients selected with perfusion imaging. We hypothesized that a persistent favorable perfusion profile exists in some patients beyond 24 hours from the onset and can be predicted by a lower baseline hypoperfusion intensity ratio, which indicates favorable collaterals.<\/jats:p>\n <\/jats:sec>\n \n Methods\u2014<\/jats:title>\n We identified control arm patients from the DEFUSE 3 trial (The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) with a diffusion weighted imaging and perfusion magnetic resonance imaging performed 24 hours following randomization and compared imaging and clinical variables between patients with persistent mismatch versus patients who no longer had a mismatch 24 hours after randomization.<\/jats:p>\n <\/jats:sec>\n \n Results\u2014<\/jats:title>\n \n Eighteen percent of the control arm patients had a persistent favorable profile >38 hours after last known well time. These patients had similar baseline diffusion weighted imaging and Tmax >6 seconds volumes as patients whose initially favorable perfusion profile became unfavorable (diffusion weighted imaging lesion 7 versus 17 mL;\n P<\/jats:italic>\n =0.17, Tmax >6 seconds 98 versus 100 mL;\n P<\/jats:italic>\n =0.48) yet experienced less infarct growth (15 versus 59 mL;\n P<\/jats:italic>\n <0.001) and had 3-fold smaller infarct volumes (15 versus 59 mL;\n P<\/jats:italic>\n <0.001) 24 hours after randomization. Patients with a persistent favorable perfusion profile had a significantly lower hypoperfusion intensity ratio on baseline imaging (0.2 versus 0.4;\n P<\/jats:italic>\n <0.01). Favorable clinical outcome at 90 days occurred in only 10% of the persistent mismatch patients.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions\u2014<\/jats:title>\n About 20% of patients with a middle cerebral artery or internal carotid artery occlusion who present in an extended time window and are not treated with thrombectomy have a persistent mismatch for at least an additional 24 hours. These patients have a favorable hypoperfusion intensity ratio at presentation, may experience delayed infarct expansion, and have poor clinical outcomes. Clinical trials are needed to determine if patients with a favorable perfusion profile benefit from reperfusion beyond 24 hours.<\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration\u2014<\/jats:title>\n \n URL:\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier: NCT02586415.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/strokeaha.118.023392","type":"journal-article","created":{"date-parts":[[2019,2,8]],"date-time":"2019-02-08T15:54:01Z","timestamp":1549641241000},"page":"754-757","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":85,"title":["Persistent Target Mismatch Profile >24 Hours After Stroke Onset in DEFUSE 3"],"prefix":"10.1161","volume":"50","author":[{"given":"S\u00f8ren","family":"Christensen","sequence":"first","affiliation":[{"name":"From the Stanford Stroke Center (S.C., M.M., S.K., A.Y., M.G.L., G.W.A.), Stanford University School of Medicine, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Mlynash","sequence":"additional","affiliation":[{"name":"From the Stanford Stroke Center (S.C., M.M., S.K., A.Y., M.G.L., G.W.A.), Stanford University School of Medicine, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Kemp","sequence":"additional","affiliation":[{"name":"From the Stanford Stroke Center (S.C., M.M., S.K., A.Y., M.G.L., G.W.A.), Stanford University School of Medicine, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amarnath","family":"Yennu","sequence":"additional","affiliation":[{"name":"From the Stanford Stroke Center (S.C., M.M., S.K., A.Y., M.G.L., G.W.A.), Stanford University School of Medicine, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy J.","family":"Heit","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology (J.J.H., M.P.M.), Stanford University School of Medicine, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Marks","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology (J.J.H., M.P.M.), Stanford University School of Medicine, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten G.","family":"Lansberg","sequence":"additional","affiliation":[{"name":"From the Stanford Stroke Center (S.C., M.M., S.K., A.Y., M.G.L., G.W.A.), Stanford University School of Medicine, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory W.","family":"Albers","sequence":"additional","affiliation":[{"name":"From the Stanford Stroke Center (S.C., M.M., S.K., A.Y., M.G.L., G.W.A.), Stanford University School of Medicine, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1713973"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493017710341"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003857"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25320"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awh162"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6569.2006.00063.x"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2015151586"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8249(199910)46:4<568::AID-ANA4>3.0.CO;2-R"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000172"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.118.023392","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:15:06Z","timestamp":1715598906000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.118.023392"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3]]},"references-count":9,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1161\/STROKEAHA.118.023392"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.118.023392","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.735053555.793556579","asserted-by":"object"}]},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3]]},"assertion":[{"value":"2018-08-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}