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CT perfusion-guided patient selection for endovascular recanalization in acute ischemic stroke: a multicenter study
  1. Aquilla S Turk1,
  2. Jordan Asher Magarick2,
  3. Don Frei3,
  4. Kyle Michael Fargen4,
  5. Imran Chaudry1,
  6. Christine A Holmstedt2,
  7. Joyce Nicholas2,
  8. J Mocco5,
  9. Raymond D Turner2,
  10. Daniel Huddle3,
  11. David Loy3,
  12. Richard Bellon3,
  13. Gwendolyn Dooley3,
  14. Robert Adams2,
  15. Michelle Whaley3,
  16. Chris Fanale3,
  17. Edward Jauch2
  1. 1Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3Department of Neurology, Radiology Imaging Associates, Englewood, Colorado, USA
  4. 4Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
  5. 5Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Dr Aquilla S Turk, Department of Radiology, Medical University of South Carolina, D.O. 169 Ashley Avenue, Charleston, SC 29425, USA; turk{at}musc.edu

Abstract

Background The treatment of acute ischemic stroke is traditionally centered on time criteria, although recent evidence suggests that physiologic neuroimaging may be useful. In a multicenter study we evaluated the use of CT perfusion, regardless of time from symptom onset, in patients selected for intra-arterial treatment of ischemic stroke.

Methods Three medical centers retrospectively assessed stroke patients with a National Institute of Health Stroke Scale of ≥8, regardless of time from symptom onset. CT perfusion maps were qualitatively assessed. Patients with defined salvageable penumbra underwent intra-arterial revascularization of their occlusion. Functional outcome using the modified Rankin Score (mRS) was recorded.

Results Two hundred and forty-seven patients were selected to undergo intra-arterial treatment based on CT perfusion imaging. The median time from symptom onset to procedure was 6 h. Patients were divided into two groups for analysis: ≤8 h and >8 h from symptom onset to endovascular procedure. We found no difference in functional outcome between the two groups (42.8% and 41.9% achieved 90-day mRS ≤ 2, respectively (p=1.0), and 54.9% vs 55.4% (p=1.0) achieved 90-day mRS ≤ 3, respectively). Overall, 48 patients (19.4%) had hemorrhages, of which 20 (8.0%) were symptomatic, with no difference between the groups (p=1.0).

Conclusions In a multicenter study, we demonstrated similar rates of good functional outcome and intracranial hemorrhage in patients with ischemic stroke when endovascular treatment was performed based on CT perfusion selection rather than time-guided selection. Our findings suggest that physiologic imaging-guided patient selection rather than time for endovascular reperfusion in ischemic stroke may be effective and safe.

  • Stroke

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