Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy

Tsogkas, Ioannis; Knauth, Michael; Schregel, Katharina; Behme, Daniel; Wasser, Katrin; Maier, Ilko; Liman, Jan; Psychogios, Marios

doi:10.1007/s00330-016-4257-y

Cited by 28 publications

(19 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The American Heart Association (AHA) guidelines 2019 do not recommend perfusion imaging in the early (0‐6 hours) window 15 . However, recent studies have suggested that advanced neuroimaging‐based selection for thrombectomy nearly doubles the probability of good functional outcomes as compared to minimalistic approach of CT/CTA‐based selection 16‐18 . All the patients in EXTEND‐IA and 80% of the patients in SWIFT PRIME, were enrolled based on the target mismatch profile on perfusion imaging 6 .…”

Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes

Bhan

Koehler²,

Elisevich

et al. 2020

Journal of Neuroimaging

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: Recent trials have shown benefit of thrombectomy in patients selected by penumbral imaging in the late (>6 hours) window. However, the role penumbral imaging is not clear in the early (0-6 hours) window. We sought to evaluate if time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on CT perfusion (CTP). METHODS: We retrospectively analyzed consecutive patients who underwent thrombectomy in a single center. Demographics, comorbidities, National Institute of Health Stroke Scale (NIHSS), rtPA administration, ASPECTS, core infarct volume, onset to skin puncture time, recanalization (mTICI IIb/III), final infarct volume were compared between patients with good and poor 90-day outcomes (mRS 0-2 vs. 3-6). Multivariable logistic regression analyses were used to identify independent predictors of a good (mRS 0-2) 90-day outcome. RESULTS: A total of 235 patients were studied, out of which 52.3% were female. Univariate analysis showed that the groups (early vs. late) were balanced for age (P = .23), NIHSS (P = .63), vessel occlusion location (P = .78), initial core infarct volume (P = .15), and recanalization (mTICI IIb/III) rates (P = .22). Favorable outcome (mRS 0-2) at 90 days (P = .30) were similar. There was a significant difference in final infarct volume (P = .04). Shift analysis did not reveal any significant difference in 90-day outcome (P = .14). After adjustment; age (P < .001), NIHSS (P = .01), recanalization (P = .008), and final infarct volume (P < .001) were predictive of favorable outcome. CONCLUSIONS: Penumbral imaging-based selection of patients for thrombectomy is effective regardless of onset time and yields similar functional outcomes in early and late window patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes

Bhan

Koehler²,

Elisevich

et al. 2020

Journal of Neuroimaging

View full text Add to dashboard Cite

show abstract

“…The underlying reasons are not clear. It could be analyzed, for instance, whether there is also a correlation of T max ASPECTS (at a delay of >8 or 10 s) with clinical outcome (Tsogkas et al., ).…”

Section: Discussionmentioning

confidence: 99%

Correlation of T_max volumes with clinical outcome in anterior circulation stroke

et al. 2017

View full text Add to dashboard Cite

Background and PurposeThe recent thrombectomy trials have shown that perfusion imaging is helpful in proper patient selection in thromboembolic stroke. In this study, we analyzed the correlation of pretreatment T max volumes in MR and CT perfusion with clinical outcome after thrombectomy.MethodsForty‐one consecutive patients with middle cerebral artery occlusion (MCA) or carotid T occlusion treated with thrombectomy were included. T max volumes at delays of >4, 6, 8, and 10 s as well as infarct core and mismatch ratio were automatically estimated in preinterventional MRI or CT perfusion using RAPID software. These perfusion parameters were correlated with clinical outcome. Outcome was assessed using modified Rankin scale at 90 days.ResultsIn patients with successful recanalization of MCA occlusion, T max > 8 and 10 s showed the best linear correlation with clinical outcome (r = 0.75; p = .0139 and r = 0.73; p = .0139), better than infarct core (r = 0.43; p = .2592). In terminal internal carotid artery occlusions, none of the perfusion parameters showed a significant correlation with clinical outcome.Conclusions T max at delays of >8 and 10 s is a good predictor for clinical outcome in MCA occlusions. In carotid T occlusion, however, T max volumes do not correlate with outcome.

show abstract

“…The latter is evaluated by applying ASPECTS to maps of the cerebral blood volume (CBV) gathered with CTP [11]. Cut-off for an EVT in the 6 to 12 hour time window is a CBV-ASPECTS of 6 and above.…”

Section: Methodsmentioning

confidence: 99%

Effects of Workflow Optimization in Endovascularly Treated Stroke Patients – A Pre-Post Effectiveness Study

et al. 2016

Self Cite

View full text Add to dashboard Cite

Endovascular treatment of acute ischemic stroke has become standard of care for patients with large artery occlusion. Early restoration of blood flow is crucial for a good clinical outcome. We introduced an interdisciplinary standard operating procedure (SOP) between neuroradiologists, neurologists and anesthesiologists in order to streamline patient management. This study analyzes the effect of optimized workflow on periprocedural timings and its potential influence on clinical outcome. Data were extracted from a prospectively maintained university hospital stroke database. The standard operating procedure was established in February 2014. Of the 368 acute stroke patients undergoing endovascular treatment between 2008 and 2015, 278 patients were treated prior to and 90 after process optimization. Outcome measures were periprocedural time intervals and residual functional impairment. After implementation of the SOP, time from symptom onset to reperfusion was significantly reduced (median 264 min prior and 211 min after SOP-introduction (IQR 228–32 min and 161–278 min, respectively); P<0.001). Especially faster supply of imaging and prompt transfer of patients to the angiography suite contributed to this effect. Time between hospital admission and groin puncture was reduced by half after process optimization (median 64 min after versus 121 min prior to SOP-introduction (IQR 54–77 min and 96–161 min, respectively); P<0.001). Clinical outcome was significantly better after workflow optimization as measured with the modified Rankin Scale (common odds ratio (OR) 0.56; 95% CI 0.32–0.98; P = 0.038). Optimization of workflow and interdisciplinary teamwork significantly improved the outcome of patients with acute ischemic stroke due to a significant reduction of in-hospital examination, transportation, imaging and treatment times.

show abstract

Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy

Abstract: • CBV-ASPECTS is a significant predictor of clinical outcome. • Single phase CTA-ASPECTS has low predictive value. • Using CBV-ASPECTS, raters identified futile reperfusions in 96 % of the cases.

Cited by 28 publications

References 25 publications

Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes

Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes

Correlation of T_max volumes with clinical outcome in anterior circulation stroke

Effects of Workflow Optimization in Endovascularly Treated Stroke Patients – A Pre-Post Effectiveness Study

Contact Info

Product

Resources

About

Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy

Abstract: • CBV-ASPECTS is a significant predictor of clinical outcome. • Single phase CTA-ASPECTS has low predictive value. • Using CBV-ASPECTS, raters identified futile reperfusions in 96 % of the cases.

Cited by 28 publications

References 25 publications

Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes

Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes

Correlation of Tmax volumes with clinical outcome in anterior circulation stroke

Effects of Workflow Optimization in Endovascularly Treated Stroke Patients – A Pre-Post Effectiveness Study

Contact Info

Product

Resources

About

Correlation of T_max volumes with clinical outcome in anterior circulation stroke