Background There are more than 700 000 new or recurrent strokes that occur in the USA each year. The majority are due to acute cerebral ischemia. Limited clinical data exist on the practical utilization of perfusion imaging patient based selection and outcomes.
Methods At a state university academic institution, the number of stroke patients treated between 9/2006 and 12/2009 were recorded. They were split into two groups. The first group were those selected and treated historically by the time from symptom onset and clinical presentation (9/2006–12/2007). The second group were those selected through the Brain Attack Triage system triaging system utilizing clinical presentation National Institutes of Health Stroke Scale (NIHSS) in addition to standard anatomic and perfusion CT imaging (1/2008–12/2009), irrespective of time from symptom onset. The clinical and angiographic outcomes will be reported only for those utilizing the perfusion based approach because of the limited number of patients prior to this. A retrospective chart review was performed to identify age, concurrent administration of intravenous tissue plasminogen activator (IV tPa), time to treatment, presenting NIHSS, 90 day modified Rankin scale (mRS) and angiographic recanalization rates.
Results The number of patients treated from 9/2006 to 12/2007 was 12 and from 1/2008 to 12/2009 was 53. The average patient was 65 years old with a median of 66 years. IV tPA was concurrently administered in 18 cases. Occluded vessel locations were: basilar (n=8); internal carotid artery (n=13); middle cerebral artery (n=31); and posterior inferior cerebellar artery (n=1). Average and median NIHSS were 17.15 and 17, respectively. The average time to treatment was 10.36 h and the median was 6.13 h. Recanalization rates were: TIMI 1: 4%, TIMI 2: 36% and TIMI 3: 60%. 90 day mRS scores were: mRS 0–2: 37%, mRS 3: 17%, mRS 4: 13%, mRS 5: 10% and mRS 6: 23%.
Conclusion The use of physiologic imaging for patient triage of acute ischemic stroke patient selection for intervention is feasible and safe. The clinical application of this approach can significantly impact the number of patients amenable to endovascular therapies.
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Competing interests AT—Boston Scientific, NFocus, Pulsar Vascular, Biomerix; RT-Micrus, Microvention, Mindframe.