Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study

Research output: Contribution to journalArticle

James E. Siegler, Steven R. Messé, Heidi Sucharew, Scott E. Kasner, Tapan Mehta, Niraj Arora, Amy K. Starosciak, Felipe De Los Rios La Rosa, Natasha R. Barnhill, Akshitkumar M. Mistry, Kishan Patel, Salman Assad, Amjad Tarboosh, Katarina Dakay, Jeff Wagner, Alicia Bennett, Bharathi Jagadeesan, Christopher Streib, Stewart A. Weber, Rohan Chitale & 6 others John Volpi, Stephan A. Mayer, Shadi Yaghi, Mahesh V. Jayaraman, Pooja Khatri, Eva A. Mistry

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.

Original languageEnglish (US)
Pages (from-to)219-226
Number of pages8
JournalJournal of Neuroimaging
Volume30
Issue number2
DOIs
StatePublished - Mar 1 2020

PMID: 31762108

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Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion : The Blood Pressure after Endovascular Stroke Therapy Study. / Siegler, James E.; Messé, Steven R.; Sucharew, Heidi; Kasner, Scott E.; Mehta, Tapan; Arora, Niraj; Starosciak, Amy K.; De Los Rios La Rosa, Felipe; Barnhill, Natasha R.; Mistry, Akshitkumar M.; Patel, Kishan; Assad, Salman; Tarboosh, Amjad; Dakay, Katarina; Wagner, Jeff; Bennett, Alicia; Jagadeesan, Bharathi; Streib, Christopher; Weber, Stewart A.; Chitale, Rohan; Volpi, John; Mayer, Stephan A.; Yaghi, Shadi; Jayaraman, Mahesh V.; Khatri, Pooja; Mistry, Eva A.

In: Journal of Neuroimaging, Vol. 30, No. 2, 01.03.2020, p. 219-226.

Research output: Contribution to journalArticle

Harvard

Siegler, JE, Messé, SR, Sucharew, H, Kasner, SE, Mehta, T, Arora, N, Starosciak, AK, De Los Rios La Rosa, F, Barnhill, NR, Mistry, AM, Patel, K, Assad, S, Tarboosh, A, Dakay, K, Wagner, J, Bennett, A, Jagadeesan, B, Streib, C, Weber, SA, Chitale, R, Volpi, J, Mayer, SA, Yaghi, S, Jayaraman, MV, Khatri, P & Mistry, EA 2020, 'Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study' Journal of Neuroimaging, vol. 30, no. 2, pp. 219-226. https://doi.org/10.1111/jon.12682

APA

Siegler, J. E., Messé, S. R., Sucharew, H., Kasner, S. E., Mehta, T., Arora, N., ... Mistry, E. A. (2020). Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study. Journal of Neuroimaging, 30(2), 219-226. https://doi.org/10.1111/jon.12682

Vancouver

Siegler JE, Messé SR, Sucharew H, Kasner SE, Mehta T, Arora N et al. Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study. Journal of Neuroimaging. 2020 Mar 1;30(2):219-226. https://doi.org/10.1111/jon.12682

Author

Siegler, James E. ; Messé, Steven R. ; Sucharew, Heidi ; Kasner, Scott E. ; Mehta, Tapan ; Arora, Niraj ; Starosciak, Amy K. ; De Los Rios La Rosa, Felipe ; Barnhill, Natasha R. ; Mistry, Akshitkumar M. ; Patel, Kishan ; Assad, Salman ; Tarboosh, Amjad ; Dakay, Katarina ; Wagner, Jeff ; Bennett, Alicia ; Jagadeesan, Bharathi ; Streib, Christopher ; Weber, Stewart A. ; Chitale, Rohan ; Volpi, John ; Mayer, Stephan A. ; Yaghi, Shadi ; Jayaraman, Mahesh V. ; Khatri, Pooja ; Mistry, Eva A. / Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion : The Blood Pressure after Endovascular Stroke Therapy Study. In: Journal of Neuroimaging. 2020 ; Vol. 30, No. 2. pp. 219-226.

BibTeX

@article{ff59985fa6a6456ea56763bf917413b7,
title = "Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study",
abstract = "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.",
keywords = "CT, CT Perfusion, Stroke",
author = "Siegler, {James E.} and Mess{\'e}, {Steven R.} and Heidi Sucharew and Kasner, {Scott E.} and Tapan Mehta and Niraj Arora and Starosciak, {Amy K.} and {De Los Rios La Rosa}, Felipe and Barnhill, {Natasha R.} and Mistry, {Akshitkumar M.} and Kishan Patel and Salman Assad and Amjad Tarboosh and Katarina Dakay and Jeff Wagner and Alicia Bennett and Bharathi Jagadeesan and Christopher Streib and Weber, {Stewart A.} and Rohan Chitale and John Volpi and Mayer, {Stephan A.} and Shadi Yaghi and Jayaraman, {Mahesh V.} and Pooja Khatri and Mistry, {Eva A.}",
year = "2020",
month = "3",
day = "1",
doi = "10.1111/jon.12682",
language = "English (US)",
volume = "30",
pages = "219--226",
journal = "Journal of Neuroimaging",
issn = "1051-2284",
publisher = "Wiley",
number = "2",

}

RIS

TY - JOUR

T1 - Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion

T2 - Journal of Neuroimaging

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

AU - Mayer, Stephan A.

AU - Yaghi, Shadi

AU - Jayaraman, Mahesh V.

AU - Khatri, Pooja

AU - Mistry, Eva A.

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

UR - http://www.scopus.com/inward/record.url?scp=85075460116&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075460116&partnerID=8YFLogxK

U2 - 10.1111/jon.12682

DO - 10.1111/jon.12682

M3 - Article

VL - 30

SP - 219

EP - 226

JO - Journal of Neuroimaging

JF - Journal of Neuroimaging

SN - 1051-2284

IS - 2

ER -

ID: 60069691