Correlation between the CT Perfusion Parameter Values and Response to Recanalization in Patients with Acute Ischemic Stroke

Hirai, Sakyo; Sato, Hirotaka; Yamamura, Toshihiro; Kato, Koichi; Ishikawa, Mariko; Sagawa, Hirotaka; Aoyama, Jiro; Fujii, Shoko; Fujita, Kyohei; Arai, Toshinari; Sumita, Kazutaka

doi:10.5797/jnet.oa.2022-0026

Cited by 1 publication

(1 citation statement)

References 32 publications

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“… 3 , 4) It is reported that the evaluation of CBV and MTT as parameters of CTP using Vitrea can predict the final volume range of cerebral infarction after recanalization of the AIS. 5) Recently, the validity of CTP has been investigated in cases where evidence still needs to be established, such as low NIHSS scores and large-core, mild cases. In cases of late time window stroke and unknown onset, DAWN 6) and Diffuse3 7) reported that MT is effective even if the treatment time is extended.…”

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confidence: 99%

Predictive Value of Acute Neurological Progression Using Bayesian CT Perfusion for Acute Ischemic Stroke with Large or Median Vessel Occlusion

Yoshii,

Fujita,

Hiramoto

et al. 2024

NOUSHINKEI KEKKANNAI TIRYOU

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Objective Since the efficacy of mechanical thrombectomy (MT) for acute cerebral infarction due to large vessel occlusion has been proven, the time available for treatment has gradually increased. Currently, under certain conditions, treatment is indicated up to 24 h from onset. Based on neurological signs and imaging diagnosis, Stroke Treatment Guideline 2021 recommends initiation of MT within 6–24 h from onset. Herein, we retrospectively investigated the relationship between cerebral perfusion imaging evaluation and prognosis in patients with acute cerebral infarction due to large or median vessel occlusion. Methods Fifty-one patients diagnosed with acute cerebral infarction due to large or median vessel occlusions in anterior circulation between November 2019 and December 2021 were divided into medical care and reconstructive therapy (including tissue plasminogen activator [t-PA] therapy and MT) groups. The primary outcome was changes in the National Institutes of Health Stroke Scale (NIHSS) at admission and 1 week after onset. Patients in the medical care group were divided into those whose NIHSS did not worsen and those whose NIHSS worsened. Those in the reconstructive therapy group were divided into those whose NIHSS improved and those whose NIHSS did not improve. We evaluated the relationship between improvement factors in acute neurological symptoms and penumbral and core volumes from computed tomography perfusion performed at admission. Results Of 45 eligible patients, 10 received medical care without t-PA or MT and 35 underwent reconstructive therapy, including t-PA and MT. Among the 10 patients in the medical care group, 3 had worsening symptoms and 7 did not. The mean and median (interquartile range [IQR]) penumbra volumes were significantly higher in patients with worsening symptoms than in those without. The receiver operating characteristic (ROC) curve showed a threshold value of 28.6 mL with an area under the curve (AUC) of 0.952. Among the 35 patients in the reconstructive therapy group, symptoms improved for 29 but did not improve for 6. The mean and median (IQR) core volumes were significantly higher in patients whose symptoms did not improve than in those whose symptoms improved. The ROC curve showed a threshold value of 25 mL and an AUC of 0.632. Conclusion Evaluation of penumbra volumes could detect cases with worsening symptoms in cases where medical care was performed, and evaluation of core volumes may detect cases with non-improved symptoms in cases that received reconstructive therapy.

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