Tissue Is More Important than Time in Stroke Patients Being Assessed for Thrombolysis

Abstract

AimThe relative prognostic importance of modern imaging profiles compared with standard clinical characteristics is uncertain in acute stroke patients. In this study, we aimed to compare baseline multimodal CT imaging measures with known clinical predictors of patient outcome at 3 months [modified Rankin scale (mRS)].MethodsWe collected baseline, 24 h, and day 90 clinical and imaging data from acute ischemic stroke patients being assessed for thrombolytic therapy between 2010 and 2015 at a single center as part of a retrospective analysis.Results561 patients presenting within 4.5 h of ischemic stroke onset who were eligible for thrombolysis based on standard clinical criteria were assessed. Acute infarct core volume on CTP was the strongest univariate predictor of patient outcome (mRS 0–2, R2 0.497, p < 0.001), followed by collateral grade (mRS 0–2, R2 0.281, p < 0.001). The strongest baseline clinical predictor of outcome was National Institutes of Health Stroke Scale (NIHSS) (mRS 0–2, R2 = 0.203, p < 0.001). Time to treatment (mRS 0–2, R2 0.096, p = 0.01) and age (mRS 0–2, R2 0.027, p = 0.013) were relatively weak univariate baseline clinical predictors of 3-month outcome. In multivariate analysis, acute infarct core volume and collateral grade were the only significant baseline predictors of 3-month disability (both p < 0.001).ConclusionIn patients assessed for thrombolysis by combined clinical and multimodal CT criteria within 4.5 h of onset, the size of the CTP infarct core and collateral grade on multimodal CT were highly predictive of patient outcome. Standard clinical variables, including time to treatment and NIHSS, were not as strongly predictive as multimodal CT variables.

The accuracy of ischemic core perfusion thresholds varies according to time to recanalization in stroke patients treated with mechanical thrombectomy: A comprehensive whole-brain computed tomography perfusion study

“…Previous studies have shown strong correlations between CTP-derived ischemic core volume estimation with both final infarct volume and clinical outcome. [4][5][6][7][8][11][12][13][14][15][16]20,21,[26][27][28][29] In agreement with these data, we found significant associations between CTP-derived ischemic core values, final infarct volume and clinical outcome at follow-up in the full cohort of patients who achieved a complete recanalization after MT. However, a number of pretreatment variables, including baseline imaging features and acute reperfusion treatment modality have been extensively proved to modify the performance of CTP for final infarct prediction.…”

Tissue no-reflow despite full recanalization following thrombectomy for anterior circulation stroke with proximal occlusion: A clinical study

“…Conversely, there was a strong association between unfavorable outcome and larger baseline DWI lesion volume, consistent with extensive previous literature. 41–43 Thus, large baseline core, rather than no-reflow , may be the main factor accounting for futile recanalizations.…”

A physiological perspective of the associations between hydration status and CTP neuroimaging parameters in hyper‐acute ischaemic stroke patients

“…Despite a growing evidence showing the association between hydration status and ischaemic stroke outcomes, few studies tried to investigate what physiological mechanisms may be involved. To the best of the author's knowledge, this is the first study attempting to show any association in hyper‐acute (<4.5 hr) stroke between hydration status and whole‐brain CTP parameters, a neuroimaging technique that gives indications of cerebral perfusion during the hyper‐acute phase of ischaemic stroke (Bivard et al., 2018; Furlanis et al., 2018, 2019; Lin et al., 2009; Manganotti et al., 2019; Shankar et al., 2016). Additionally, this study separately analyses blood and urine biomarkers of hydration status that may differently affect ischaemic lesion.…”