Chung, et al. #1
SUPPLEMENTARY MATERIALS
Impact of Penumbra Patterns on Clinical Outcome in Patients with Successful Endovascular Revascularization
Jong-Won Chung, MD, MSc1; Jun Yup Kim, MD, MSc2; Hong-Kyun Park, MD, MSc2; Beom Joon Kim, MD, PhD2; Moon-Ku Han, MD, PhD2; Jun Lee, MD, PhD5; Kang-Ho Choi, MD, PhD6; Joon-Tae Kim, MD, PhD6; Cheolkyu Jung, MD, PhD3; Jae Hyoung Kim, MD, PhD3; O-Ki Kwon, MD, PhD4; Chang Wan Oh, MD, PhD4; Juneyoung Lee, PhD7; Hee-Joon Bae, MD, PhD2
Department of Neurology1, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Departments of Neurology2, Radiology3, and Neurosurgery4, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea; Department of Neurology5, Yeungnam University Hospital, Daegu, Republic of Korea; Department of Neurology6, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Biostatistics7, Korea University College of Medicine, Seoul, Republic of Korea
Supplemental Table I. Patient’s characteristics by early versus late revascularization
Supplemental Table II. Sensitivity analysis in a subgroup of patients with mTICI 3 for functional independence defined as a 90-day mRS of 0-2
Supplemental Table III. Sensitivity analysis in all study subjects for functional independence defined as a 90-day mRS of 0-1
Supplemental Table IV. Methods of endovascular treatment
Supplemental Table V. Details of time intervals between arrival and groin puncture
Supplemental Figure I. Patient selection
Chung, et al. #1
Supplemental Table I. Patient’s characteristics by early versus late revascularization
Early revascularization* n = 61 / Late revascularization n = 60 / P valueMale sex - no. (%) / 30 (49.2) / 35 (58.3) / 0.31
Age (year) / 69.8 ± 11.9 / 68.7 ± 12.5 / 0.64
Body mass index (kg/m2) / 23.6 ± 2.8 / 23.0 ± 3.7 / 0.33
Systolic blood pressure (mm hg) / 136.0 ± 24.0 / 142.1 ± 22.7 / 0.16
Overnight fasting glucose (mg/dL) / 121.3 ± 47 / 119.0 ± 41.2 / 0.78
Total Cholesterol (mg/dL) / 165.8 ± 48.1 / 171.3 ± 39.4 / 0.49
LDL Cholesterol (mg/dL) / 101.3 ± 43.9 / 107.1 ± 35.7 / 0.43
Medical history
Previous ischemic stroke - no. (%) / 10 (16.4) / 13 (21.7) / 0.46
History of hypertension - no. (%) / 30 (49.2) / 34 (56.7) / 0.41
History of diabetes - no. (%) / 19 (31.1) / 16 (26.7) / 0.59
History of hypercholesterolemia - no. (%) / 14 (23.0) / 10 (16.7) / 0.39
History of atrial fibrillation - no. (%) / 26 (42.6) / 19 (31.7) / 0.21
Ever-smoking - no. (%) / 17 (27.9) / 26 (43.3) / 0.08
Stroke profile
Onset to arrival (min) / 62.3 ± 36.0 / 221.2 ± 123.5 / 0.001
NIHSS at admission [median (IQR)] / 15 (10.0–19.0) / 12 (8.0–17.0) / 0.04
TOAST classification - no. (%) / 0.15
Large artery atherosclerosis / 11 (18.0) / 16 (26.7)
Small vessel occlusion / 0 (0.0) / 0 (0.0)
Cardioembolism / 44 (72.1) / 33 (55.0)
Other determined / 2 (3.3) / 1 (1.7)
Undetermined / 4 (6.6) / 10 (16.7)
Imaging profile
Onset to MRI (min) / 101.3 ± 41.4 / 255.5 ± 128.4 / 0.001
Initial DWI lesion volume (ml) / 21.7 ± 30.5 / 20.7 ± 24.2 / 0.83
Tmax > 6 sec volume (ml) / 93.3 ± 56.7 / 99.0 ± 55.9 / 0.58
Favorable penumbra pattern / 48 (78.7) / 56 (93.3) / 0.02
Stroke treatment
IV thrombolysis prior to endovascular treatment - no. (%) / 39 (63.9) / 27 (45.0) / 0.04
Onset to initiation of IV thrombolysis (min) / 97.1 ± 33.7 / 150.5 ± 58.4 / 0.001
Onset to initiation of endovascular treatment (min) / 162.9 ± 39.1 / 352.1 ± 124.8 / 0.001
Onset to revascularization (min) / 202.3 ± 43.0 / 412.7 ± 116.3 / 0.001
*Early revascularization was defined by median value of interval from symptom onset to revascularization time in study population.
Values are mean ± standard deviation, unless noted otherwise.
Abbreviations: LDL, low-density lipoprotein; NIHSS, National Institutes of Health stroke scale; IQR, interquartile range; TOAST, trial of ORG 10172 in acute stroke treatment; MRI, magnetic resonance image; DWI, diffusion-weighted imaging; IV, intravenous.
Supplemental Table II. Sensitivity analysis in a subgroup of patients with mTICI 3 for functional independence defined as a 90-day mRS of 0-2
Univariate analysis / Multivariable analysisOR (95% CI) / P value / OR (95% CI) / P value
Male sex / 2.23 (0.86–5.81) / 0.10
Mean age - by 5 year increase / 0.63 (0.48–0.83) / 0.001 / 0.56 (0.38–0.83) / < 0.01
Body mass index (kg/m2) / 1.08 (0.94–1.24) / 0.30
Systolic blood pressure - by 10 mg/dL increase / 0.92 (0.76–1.12) / 0.41
Overnight fasting glucose - by 10 mg/dL increase / 0.90 (0.79–1.02) / 0.11
Total Cholesterol - by 10 mg/dL increase / 1.03 (0.91–1.16) / 0.67
LDL Cholesterol - by 10 mg/dl increase / 1.03 (0.90–1.18) / 0.69
Previous ischemic stroke / 0.13 (0.03–0.66) / 0.01 / 0.08 (0.01–0.60) / 0.01
History of hypertension / 0.39 (0.15–1.02) / 0.06
History of diabetes / 0.39 (0.14–1.07) / 0.07
History of hypercholesterolemia / 1.45 (0.45–4.62) / 0.53
History of atrial fibrillation / 0.65 (0.25–1.73) / 0.39
Ever-smoking / 2.27 (0.83–6.18) / 0.11
NIHSS at admission / 0.86 (0.79–0.95) / <0.01 / 0.86 (0.76–0.99) / 0.03
TOAST classification
Large artery atherosclerosis / 1 (reference)
Small vessel occlusion / NA
Cardioembolism / 1.91 (0.54–6.71) / 0.32
Other determined / NA / 0.48
Undetermined / 2.00 (0.36–11.23) / 0.43
Favorable penumbral pattern / 11.52 (1.36–97.97) / 0.03 / 6.92 (0.44–107.87) / 0.17
Initial DWI lesion volume - by 10 ml increase / 0.63 (0.44–0.89) / 0.01 / 0.78 (0.50–1.21) / 0.26
Tmax > 6sec volume - by 10 ml increase / 0.96 (0.87–1.05) / 0.36
IVT prior to EVT / 1.22 (0.47–3.16) / 0.68
Onset to revascularization - by 10 min increase / 0.99 (0.95–1.02) / 0.34
Abbreviations: mTICI, modified Thrombolysis in Cerebral Infarction; OR, odds ratio; CI, confidence interval; LDL, low-density lipoprotein; NIHSS, National Institutes of Health stroke scale; TOAST, trial of ORG 10172 in acute stroke treatment; DWI, diffusion-weighted imaging; IVT, intravenous thrombolysis; EVT, endovascular treatment.
Supplemental Table III. Sensitivity analysis in all study subjects for functional independence defined as a 90-day mRS of 0-1
Univariate analysis / Multivariable analysisOR (95% CI) / P value / OR (95% CI) / P value
Male sex / 1.17 (0.55–2.53) / 0.68
Mean age - by 5 year increase / 0.72 (0.60–0.87) / < 0.001 / 0.75 (0.60–0.94) / 0.01
Body mass index (kg/m2) / 1.07 (0.95–1.21) / 0.26
Systolic blood pressure - by 10 mg/dL increase / 0.95 (0.81–1.12) / 0.54
Overnight fasting glucose - by 10 mg/dL increase / 0.85 (0.74–0.97) / 0.02 / 0.82 (0.71–0.96) / 0.01
Total Cholesterol - by 10 mg/dL increase / 1.00 (0.91–1.09) / 0.91
LDL Cholesterol - by 10 mg/dl increase / 0.98 (0.89–1.09) / 0.74
Previous ischemic stroke / 0.38 (0.12–1.20) / 0.10
History of hypertension / 0.49 (0.23–1.07) / 0.73
History of diabetes / 0.53 (0.21–1.30) / 0.16
History of hypercholesterolemia / 1.34 (0.53–3.40) / 0.54
History of atrial fibrillation / 1.08 (0.49–2.38) / 0.84
Ever-smoking / 1.21 (0.55–2.66) / 0.64
NIHSS at admission / 0.84 (0.78–0.91) / <0.001 / 0.86 (0.78–0.95) / < 0.01
TOAST classification
Large artery atherosclerosis / 1 (reference)
Small vessel occlusion / NA
Cardioembolism / 1.46 (0.55–3.89) / 0.45
Other determined / 1.43 (0.11–18.30) / 0.78
Undetermined / 1.59 (0.40–6.38) / 0.52
Favorable penumbral pattern / 9.21 (1.18–72.23) / 0.04 / 6.07 (0.47–77.84) / 0.17
Initial DWI lesion volume - by 10 ml increase / 0.48 (0.31–0.75) / < 0.01 / 0.69 (0.45–1.07) / 0.10
Tmax > 6sec volume - by 10 ml increase / 0.94 (0.87–1.01) / 0.11
IVT prior to EVT / 0.82 (0.38–1.77) / 0.62
Onset to revascularization - by 10 min increase / 1.01 (0.98–1.04) / 0.65
Abbreviations: OR, odds ratio; CI, confidence interval; LDL, low-density lipoprotein; NIHSS, National Institutes of Health stroke scale; TOAST, trial of ORG 10172 in acute stroke treatment; DWI, diffusion-weighted imaging; IVT, intravenous thrombolysis; EVT, endovascular treatment.
Supplemental Table IV. Methods of endovascular treatment
Chemical thrombolysis / 65 (53.7)
Mechanical thrombolysis / 39 (32.5)
Penumbra system / 17 (14.0)
Solitaire device / 75 (62.0)
Chemical thrombolysis, use of urokinase, Reopro and/or Tirofiban; Mechanical thrombolysis, penetration of a microcatheter/microwire multiple times through the clot; Penumbra system, Penumbra reperfusion catheter; Solitaire device, Solitaire FR device for clot retrieval.
The percentiles of individual methods do not sum up to 100% because their use was overlapped in each individual.
Supplemental Table V. Details of time intervals between arrival and groin puncture
Patients with pre-EVT r-tPA (n = 66) / Patients without pre-EVT r-tPA (n = 55) / Total (n = 121)Arrival to CT / 17 / Arrival to MRI / 36 / Arrival to first brain image / 24
CT to start of MRI / 23.5
CT to end of MRI / 46
CT to groin puncture / 95 / MRI to groin puncture / 50 / First brain image to groin puncture / 77
Arrival to groin puncture / 109 / Arrival to groin puncture / 98 / Arrival to groin puncture / 104
Values are presented in median (min).
Abbreviations: EVT, endovascular treatment; CT, computed tomography; MRI, magnetic resonance imaging.
Supplemental Figure I. Patient selection
Abbreviations: EVT, endovascular treatment; mTICI, modified Thrombolysis in Cerebral Infarction; MRI, magnetic resonance imaging; mRS, modified Rankin Scale.