Laura Strada1, Jonathan Y Streifler2, Bruno Del Sette3, Matteo Puntoni4, Antonio Castaldi5, Daria Bianchini6, Massimo Del Sette6. 1. Neurology Unit.E.O. Ospedali Galliera, Via Mura delle Cappuccine 14, 16128, Genoa, Italy. laura.strada@galliera.it. 2. Neurology Department, Rabin Medical Center, Petach Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Radiology Unit, University of Novara, Novara, Italy. 4. Clinical Trial Unit, Office of Scientific Director, E.O. Ospedali Galliera, Genoa, Italy. 5. Neuroradiology Unit, E.O. Ospedali Galliera, Genoa, Italy. 6. Neurology Unit.E.O. Ospedali Galliera, Via Mura delle Cappuccine 14, 16128, Genoa, Italy.
Abstract
BACKGROUND: Intravenous tPA is the standard treatment for acute ischemic stroke within 4.5 hours of symptom onset. Neuroradiological selection is currently based upon non-contrast- brain CT scan (NCCT). AIMS: To verify, in an "expert-opinion setting", the possible usefulness of CT perfusion (CTP) in decision-making toward i.v. thrombolysis. PATIENTS AND METHOD: One hundred and three consecutive patients with acute ischemic stroke who underwent NCCT and CTP were re-evaluated by an expert in cerebrovascular disease, to verify if adding CTP information would have changed expert's opinion. RESULTS: After CTP, a definitive decision was made for 20 more patients, changing the proportion of patients candidate to i.v. tPA from 44% to 51%, and reducing uncertainty from 29% to 10%. CTP results were useful inmilder stroke (p = 0.01). CONCLUSIONS: In a "real world" setting, CT perfusion could be useful for clinical decision, in particular for milder stroke.
BACKGROUND: Intravenous tPA is the standard treatment for acute ischemic stroke within 4.5 hours of symptom onset. Neuroradiological selection is currently based upon non-contrast- brain CT scan (NCCT). AIMS: To verify, in an "expert-opinion setting", the possible usefulness of CT perfusion (CTP) in decision-making toward i.v. thrombolysis. PATIENTS AND METHOD: One hundred and three consecutive patients with acute ischemic stroke who underwent NCCT and CTP were re-evaluated by an expert in cerebrovascular disease, to verify if adding CTP information would have changed expert's opinion. RESULTS: After CTP, a definitive decision was made for 20 more patients, changing the proportion of patients candidate to i.v. tPA from 44% to 51%, and reducing uncertainty from 29% to 10%. CTP results were useful inmilder stroke (p = 0.01). CONCLUSIONS: In a "real world" setting, CT perfusion could be useful for clinical decision, in particular for milder stroke.
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