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Original research
Optimal thresholds for ischemic penumbra predicted by computed tomography perfusion in patients with acute ischemic stroke treated with mechanical thrombectomy
  1. Katsuharu Kameda,
  2. Junji Uno,
  3. Ryosuke Otsuji,
  4. Nice Ren,
  5. Shintaro Nagaoka,
  6. Kazushi Maeda,
  7. Yoshiaki Ikai,
  8. Hidefuku Gi
  1. Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan
  1. Correspondence to Dr Katsuharu Kameda, Department of Neurosurgery, Baba Memorial Hospital, 4-244 Hamaderafunaochou Higashi, Nishi-ku, Sakai City, Osaka 592-8341, Japan; kkameda55med{at}gmail.com

Abstract

Background and purpose Optimal thresholds for ischemic penumbra detected by CT perfusion (CTP) in patients with acute ischemic stroke (AIS) have not been elucidated. In this study we investigated optimal thresholds for salvageable ischemic penumbra and the risk of hemorrhagic transformation (HT).

Methods A total of 156 consecutive patients with AIS treated with mechanical thrombectomy (MT) at our hospital were enrolled. Absolute (a) and relative (r) CTP parameters including cerebral blood flow (aCBF and rCBF), cerebral blood volume (aCBV and rCBV), and mean transit time (aMTT and rMTT) were evaluated for their value in detecting ischemic penumbra in each of seven arbitrary regions of interest defined by the major supplying blood vessel. Optimal thresholds were calculated by performing receiver operating characteristic curve analysis in 47 patients who achieved Thrombolysis In Cerebral Infarction (TICI) grade 3 recanalization. The risk of HT after MT was evaluated in 101 patients who achieved TICI grade 2b–3 recanalization.

Results Absolute CTP parameters for distinguishing ischemic penumbra from ischemic core were as follows: aCBF, 27.8 mL/100 g/min (area under the curve 0.82); aCBV, 2.1 mL/100 g (0.75); and aMTT, 7.30 s (0.70). Relative CTP parameters were as follows: rCBF, 0.62 (0.81); rCBV, 0.83 (0.87); and rMTT, 1.61 (0.73). CBF was significantly lower in areas of HT than in areas of infarction (aCBF, p<0.01; rCBF, p<0.001).

Conclusions CTP may be able to predict treatable ischemic penumbra and the risk of HT after MT in patients with AIS.

  • Blood Flow
  • CT perfusion
  • Hemorrhage
  • Stroke
  • Thrombectomy

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Footnotes

  • Contributors KK: Substantial contributions to the conception or design of the work; the acquisition, analysis, or interpretation of data; drafting of the manuscript or revising it critically for important intellectual content; final approval of the version to be published; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JU: Substantial contributions to the acquisition, analysis, or interpretation of data; editing of the manuscript; final approval of the version to be published. RO, RN, SN, KM, YI: Substantial contributions to the acquisition of data, final approval of the version to be published. HG: Supervised the project; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Ethics approval Research Ethics Committee of Baba Memorial Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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