Sivan-Hoffmann Rotem1,2, Saban Mor3, Buxbaum Chen4, Srour Firas1, Sprecher Elliot4, Eran Ayelet1, Abergel Eitan2, Telman Gregory4,5. 1. Department of Radiology, Rambam Health Care Campus, Haifa, Israel. 2. Department of Interventional Neuroradiology, Rambam Health Care Campus, Haifa, Israel. 3. Emergency Department, Rambam Health Care Campus, Haifa, Israel. 4. Department of Neurology, Rambam Health Care Campus, Haifa, Israel. 5. Technion Faculty of Medicine, Haifa, Israel.
Abstract
BACKGROUND AND PURPOSE: In the setting of an extended time window for endovascular treatment (EVT) for acute stroke patients, computed tomography perfusion (CTP) has become a major tool in patient selection. However, there are some data suggesting that the initial ischemic core may be overestimated by CTP depending on stroke onset time. This study aims to evaluate possible predictors of overestimation of infarct core by CTP. METHODS: We studied all consecutive stroke patients undergoing EVT during 1 year who underwent CTP at admission and had a successful recanalization. Admission infarct core was measured on cerebral blood volume maps generated using the Intellispace Portal (Philips Healthcare, Best, the Netherlands) and final infarct was measured on noncontrast follow-up computed tomography at 24 hours. We defined overestimation of the infarct core as initial core minus final infarct >10 mL. RESULTS: Out of 107 patients undergoing EVT in the study period, 60 were anterior circulation and had CTP done at our institute, and of them 31 were compatible with the inclusion criteria (known time of onset, no hemorrhagic conversion, and good recanalization). Median National Institute of Health Stroke Scale on admission was 13. Median time from symptoms to CTP was 148 minutes. Seventeen patients were found to have overestimation of the infarct core. Logistic regression analyses showed time from symptom onset to CTP to be inversely related to overestimation with a cutoff of 170 minutes (sensitivity 94% and specificity 43%). CONCLUSION: Over estimation of the infarct core by CTP in patients undergoing EVT is time dependent and so CTP results among early arrivers should be interpreted cautiously.
BACKGROUND AND PURPOSE: In the setting of an extended time window for endovascular treatment (EVT) for acute strokepatients, computed tomography perfusion (CTP) has become a major tool in patient selection. However, there are some data suggesting that the initial ischemic core may be overestimated by CTP depending on stroke onset time. This study aims to evaluate possible predictors of overestimation of infarct core by CTP. METHODS: We studied all consecutive strokepatients undergoing EVT during 1 year who underwent CTP at admission and had a successful recanalization. Admission infarct core was measured on cerebral blood volume maps generated using the Intellispace Portal (Philips Healthcare, Best, the Netherlands) and final infarct was measured on noncontrast follow-up computed tomography at 24 hours. We defined overestimation of the infarct core as initial core minus final infarct >10 mL. RESULTS: Out of 107 patients undergoing EVT in the study period, 60 were anterior circulation and had CTP done at our institute, and of them 31 were compatible with the inclusion criteria (known time of onset, no hemorrhagic conversion, and good recanalization). Median National Institute of Health Stroke Scale on admission was 13. Median time from symptoms to CTP was 148 minutes. Seventeen patients were found to have overestimation of the infarct core. Logistic regression analyses showed time from symptom onset to CTP to be inversely related to overestimation with a cutoff of 170 minutes (sensitivity 94% and specificity 43%). CONCLUSION: Over estimation of the infarct core by CTP in patients undergoing EVT is time dependent and so CTP results among early arrivers should be interpreted cautiously.
Authors: S Nannoni; F Ricciardi; D Strambo; G Sirimarco; M Wintermark; V Dunet; P Michel Journal: AJNR Am J Neuroradiol Date: 2021-01-28 Impact factor: 3.825
Authors: A Potreck; C S Weyland; F Seker; U Neuberger; C Herweh; A Hoffmann; S Nagel; M Bendszus; M A Mutke Journal: Clin Neuroradiol Date: 2021-10-28 Impact factor: 3.649
Authors: Noemie Ligot; Sophie Elands; Charlotte Damien; Lise Jodaitis; Niloufar Sadeghi Meibodi; Benjamin Mine; Thomas Bonnet; Adrien Guenego; Boris Lubicz; Gilles Naeije Journal: Front Neurol Date: 2022-02-21 Impact factor: 4.003