TY - JOUR
T1 - Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion
T2 - The Blood Pressure after Endovascular Stroke Therapy Study
AU - Siegler, James E.
AU - Messé, Steven R.
AU - Sucharew, Heidi
AU - Kasner, Scott E.
AU - Mehta, Tapan
AU - Arora, Niraj
AU - Starosciak, Amy K.
AU - De Los Rios La Rosa, Felipe
AU - Barnhill, Natasha R.
AU - Mistry, Akshitkumar M.
AU - Patel, Kishan
AU - Assad, Salman
AU - Tarboosh, Amjad
AU - Dakay, Katarina
AU - Wagner, Jeff
AU - Bennett, Alicia
AU - Jagadeesan, Bharathi
AU - Streib, Christopher
AU - Weber, Stewart A.
AU - Chitale, Rohan
AU - Volpi, John J.
AU - Mayer, Stephan A.
AU - Yaghi, Shadi
AU - Jayaraman, Mahesh V.
AU - Khatri, Pooja
AU - Mistry, Eva A.
N1 - Funding Information:
The authors report no competing financial interests exist. This work was supported by a Society of Vascular and Interventional Neurology (SVIN) pilot grant, University of Cincinnati Gardner Neuroscience Institute pilot grant, National Institutes of Health U01 NS086872, National Institutes of Health U10 NS086512, and National Institutes of Health U10 NS086474.
Publisher Copyright:
© 2019 by the American Society of Neuroimaging
PY - 2020/3/1
Y1 - 2020/3/1
N2 - BACKGROUND AND PURPOSE: The 2018 AHA guidelines recommend perfusion imaging to select patients with acute large vessel occlusion (LVO) for thrombectomy in the extended window. However, the relationship between noncontrast CT and CT perfusion imaging has not been sufficiently characterized >6 hours after last known normal (LKN).METHODS: From a multicenter prospective cohort of consecutive adults who underwent thrombectomy for anterior LVO 0-24 hours after LKN, we correlated baseline core volume (rCBF < 30%) and the Alberta Stroke Program Early CT Scale (ASPECTS) score. We compared perfusion findings between patients with an unfavorable ASPECTS (<6) against those with a favorable ASPECTS (≥6), and assessed findings over time.RESULTS: Of 485 enrolled patients, 177 met inclusion criteria (median age: 69 years, interquartile range [IQR: 57-81], 49% female, median ASPECTS 8 [IQR: 6-9], median core 10 cc [IQR: 0-30]). ASPECTS and core volume moderately correlated (r = -.37). A 0 cc core was observed in 54 (31%) patients, 70% of whom had ASPECTS <10. Of the 28 patients with ASPECTS <6, 3 (11%) had a 0 cc core. After adjustment for age and stroke severity, there was a lower ASPECTS for every 1 hour delay from LKN (cOR: 0.95, 95% confidence of interval [CI]: 0.91-1.00, P = .04). There was no difference in core (P = .51) or penumbra volumes (P = .87) across patients over time.CONCLUSIONS: In this multicenter prospective cohort of patients who underwent thrombectomy, one-third of patients had normal CTP core volumes despite nearly three quarters of patients showing ischemic changes on CT. This finding emphasizes the need to carefully assess both noncontrast and perfusion imaging when considering thrombectomy eligibility.
AB - BACKGROUND AND PURPOSE: The 2018 AHA guidelines recommend perfusion imaging to select patients with acute large vessel occlusion (LVO) for thrombectomy in the extended window. However, the relationship between noncontrast CT and CT perfusion imaging has not been sufficiently characterized >6 hours after last known normal (LKN).METHODS: From a multicenter prospective cohort of consecutive adults who underwent thrombectomy for anterior LVO 0-24 hours after LKN, we correlated baseline core volume (rCBF < 30%) and the Alberta Stroke Program Early CT Scale (ASPECTS) score. We compared perfusion findings between patients with an unfavorable ASPECTS (<6) against those with a favorable ASPECTS (≥6), and assessed findings over time.RESULTS: Of 485 enrolled patients, 177 met inclusion criteria (median age: 69 years, interquartile range [IQR: 57-81], 49% female, median ASPECTS 8 [IQR: 6-9], median core 10 cc [IQR: 0-30]). ASPECTS and core volume moderately correlated (r = -.37). A 0 cc core was observed in 54 (31%) patients, 70% of whom had ASPECTS <10. Of the 28 patients with ASPECTS <6, 3 (11%) had a 0 cc core. After adjustment for age and stroke severity, there was a lower ASPECTS for every 1 hour delay from LKN (cOR: 0.95, 95% confidence of interval [CI]: 0.91-1.00, P = .04). There was no difference in core (P = .51) or penumbra volumes (P = .87) across patients over time.CONCLUSIONS: In this multicenter prospective cohort of patients who underwent thrombectomy, one-third of patients had normal CTP core volumes despite nearly three quarters of patients showing ischemic changes on CT. This finding emphasizes the need to carefully assess both noncontrast and perfusion imaging when considering thrombectomy eligibility.
KW - CT
KW - CT Perfusion
KW - Stroke
KW - Blood Pressure/physiology
KW - Prospective Studies
KW - Alberta
KW - Tomography, X-Ray Computed/methods
KW - Humans
KW - Middle Aged
KW - Perfusion Imaging/methods
KW - Stroke/diagnostic imaging
KW - Endovascular Procedures
KW - Male
KW - Thrombectomy/methods
KW - Aged, 80 and over
KW - Female
KW - Aged
KW - Retrospective Studies
KW - Brain Ischemia/diagnostic imaging
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U2 - 10.1111/jon.12682
DO - 10.1111/jon.12682
M3 - Article
C2 - 31762108
AN - SCOPUS:85075460116
SN - 1051-2284
VL - 30
SP - 219
EP - 226
JO - Journal of Neuroimaging
JF - Journal of Neuroimaging
IS - 2
ER -