S Dehkharghani1, R Bammer2, M Straka3, M Bowen4, J W Allen5, S Rangaraju6, J Kang7, T Gleason4, C Brasher6, F Nahab6. 1. From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.) Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia Seena.Dehkharghani@Emory.edu. 2. Department of Radiology (R.B.), Stanford University Hospital, Stanford, California. 3. Institut für Radiologie und Nuklearmedizin (M.S.), Kantonsspital Winterthur, Winterthur, Switzerland. 4. From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.). 5. From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.) Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia. 6. Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia. 7. Department of Biostatistics (J.K.), University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND AND PURPOSE: Endovascular trials suggest that revascularization benefits a subset of acute ischemic stroke patients with large-artery occlusion and small-core infarct volumes. The objective of our study was to identify thresholds of noncontrast CT-ASPECTS and collateral scores on CT angiography that best predict ischemic core volume thresholds quantified by CT perfusion among patients with acute ischemic stroke. MATERIALS AND METHODS: Fifty-four patients with acute ischemic stroke (<12 hours) and MCA/intracranial ICA occlusion underwent NCCT/CTP during their initial evaluation. CTP analysis was performed on a user-independent platform (RApid processing of PerfusIon and Diffusion), computing core infarct (defined as CBF of <30% normal). A target mismatch profile consisting of infarction core of ≤50 mL was selected to define candidates with acute ischemic stroke likely to benefit from revascularization. RESULTS: NCCT-ASPECTS of ≥9 with a CTA collateral score of 3 had 100% specificity for identifying patients with a CBF core volume of ≤50 mL. NCCT-ASPECTS of ≤6 had 100% specificity for identifying patients with a CBF core volume of >50 mL. In our cohort, 44 (81%) patients had an NCCT-ASPECTS of ≥9, a CTA collateral score of 3, or an NCCT-ASPECTS of ≤6. CONCLUSIONS: Using an NCCT-ASPECTS of ≥9 or a CTA collateral score of 3 best predicts CBF core volume infarct of ≤50 mL, while an NCCT-ASPECTS of ≤6 best predicts a CBF core volume infarct of >50 mL. Together these thresholds suggest that a specific population of patients with acute ischemic stroke not meeting such profiles may benefit most from CTP imaging to determine candidacy for revascularization.
BACKGROUND AND PURPOSE: Endovascular trials suggest that revascularization benefits a subset of acute ischemic strokepatients with large-artery occlusion and small-core infarct volumes. The objective of our study was to identify thresholds of noncontrast CT-ASPECTS and collateral scores on CT angiography that best predict ischemic core volume thresholds quantified by CT perfusion among patients with acute ischemic stroke. MATERIALS AND METHODS: Fifty-four patients with acute ischemic stroke (<12 hours) and MCA/intracranial ICA occlusion underwent NCCT/CTP during their initial evaluation. CTP analysis was performed on a user-independent platform (RApid processing of PerfusIon and Diffusion), computing core infarct (defined as CBF of <30% normal). A target mismatch profile consisting of infarction core of ≤50 mL was selected to define candidates with acute ischemic stroke likely to benefit from revascularization. RESULTS:NCCT-ASPECTS of ≥9 with a CTA collateral score of 3 had 100% specificity for identifying patients with a CBF core volume of ≤50 mL. NCCT-ASPECTS of ≤6 had 100% specificity for identifying patients with a CBF core volume of >50 mL. In our cohort, 44 (81%) patients had an NCCT-ASPECTS of ≥9, a CTA collateral score of 3, or an NCCT-ASPECTS of ≤6. CONCLUSIONS: Using an NCCT-ASPECTS of ≥9 or a CTA collateral score of 3 best predicts CBF core volume infarct of ≤50 mL, while an NCCT-ASPECTS of ≤6 best predicts a CBF core volume infarct of >50 mL. Together these thresholds suggest that a specific population of patients with acute ischemic stroke not meeting such profiles may benefit most from CTP imaging to determine candidacy for revascularization.
Authors: Maarten G Lansberg; Matus Straka; Stephanie Kemp; Michael Mlynash; Lawrence R Wechsler; Tudor G Jovin; Michael J Wilder; Helmi L Lutsep; Todd J Czartoski; Richard A Bernstein; Cherylee W J Chang; Steven Warach; Franz Fazekas; Manabu Inoue; Aaryani Tipirneni; Scott A Hamilton; Greg Zaharchuk; Michael P Marks; Roland Bammer; Gregory W Albers Journal: Lancet Neurol Date: 2012-09-04 Impact factor: 44.182
Authors: S Dehkharghani; R Bammer; M Straka; L S Albin; O Kass-Hout; J W Allen; S Rangaraju; D Qiu; M J Winningham; F Nahab Journal: AJNR Am J Neuroradiol Date: 2015-05-21 Impact factor: 3.825
Authors: Bruce C V Campbell; Søren Christensen; Christopher R Levi; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis; Mark W Parsons Journal: Stroke Date: 2011-10-06 Impact factor: 7.914
Authors: Raul G Nogueira; Helmi L Lutsep; Rishi Gupta; Tudor G Jovin; Gregory W Albers; Gary A Walker; David S Liebeskind; Wade S Smith Journal: Lancet Date: 2012-08-26 Impact factor: 79.321
Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Mayank Goyal; Andrew M Demchuk; Bijoy K Menon; Muneer Eesa; Jeremy L Rempel; John Thornton; Daniel Roy; Tudor G Jovin; Robert A Willinsky; Biggya L Sapkota; Dar Dowlatshahi; Donald F Frei; Noreen R Kamal; Walter J Montanera; Alexandre Y Poppe; Karla J Ryckborst; Frank L Silver; Ashfaq Shuaib; Donatella Tampieri; David Williams; Oh Young Bang; Blaise W Baxter; Paul A Burns; Hana Choe; Ji-Hoe Heo; Christine A Holmstedt; Brian Jankowitz; Michael Kelly; Guillermo Linares; Jennifer L Mandzia; Jai Shankar; Sung-Il Sohn; Richard H Swartz; Philip A Barber; Shelagh B Coutts; Eric E Smith; William F Morrish; Alain Weill; Suresh Subramaniam; Alim P Mitha; John H Wong; Mark W Lowerison; Tolulope T Sajobi; Michael D Hill Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: R I Aviv; J Mandelcorn; S Chakraborty; D Gladstone; S Malham; G Tomlinson; A J Fox; S Symons Journal: AJNR Am J Neuroradiol Date: 2007-10-05 Impact factor: 3.825
Authors: Imanuel Dzialowski; Michael D Hill; Shelagh B Coutts; Andrew M Demchuk; David M Kent; Olaf Wunderlich; Rüdiger von Kummer Journal: Stroke Date: 2006-02-23 Impact factor: 7.914
Authors: M Laflamme; S Carrondo-Cottin; M-M Valdès; D Simonyan; M-È Audet; J-L Gariépy; M-C Camden; C Gariépy; S Verreault; P Lavoie Journal: AJNR Am J Neuroradiol Date: 2022-09-22 Impact factor: 4.966
Authors: Jason W Allen; Adam Prater; Omar Kallas; Syed A Abidi; Brian M Howard; Frank Tong; Shashank Agarwal; Shadi Yaghi; Seena Dehkharghani Journal: J Am Heart Assoc Date: 2021-12-31 Impact factor: 5.501