RT Journal Article
SR Electronic
T1 Systematic CT perfusion acquisition in acute stroke increases vascular occlusion detection and thrombectomy rates
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1270
OP 1273
DO 10.1136/neurintsurg-2021-018241
VO 14
IS 12
A1 Olive-Gadea, Marta
A1 Requena, Manuel
A1 Diaz, Facundo
A1 Boned, Sandra
A1 Garcia-Tornel, Alvaro
A1 Muchada, Marian
A1 Deck, Matias
A1 Lozano, Prudencio
A1 Rodriguez-Villatoro, Noelia
A1 Juega, Jesus
A1 Pagola, Jorge
A1 Rodriguez-Luna, David
A1 Rubiera, Marta
A1 Marti, Cristian
A1 Molina, Carlos A
A1 Piñana, Carlos
A1 Hernandez, David
A1 Tomasello, Alejandro
A1 Ribo, Marc
YR 2022
UL http://jnis.bmj.com/content/14/12/1270.abstract
AB Background In patients with stroke, current guidelines recommend non-invasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols.Methods From April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT, CTA and CTP and were treated accordingly. Hypoperfusion areas defined by time-to-maximum of the tissue residue function (Tmax) >6 s, congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated non-contrast CT and CTA to identify intracranial VO (CTA-VO).Results Of the 338 patients included in the analysis, 157 (46.5%) presented with CTP-VO (median Tmax >6s: 73 (29–127) mL). CTA-VO was identified in 83 (24.5%) of the cases. Overall CTA-VO sensitivity for the detection of CTP-VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with increased CTA-VO detection (OR 1.03; 95% CI 1.02 to 1.04). EVT was performed in 103 patients (30.5%; Tmax >6s: 102 (63–160) mL), representing 65.6% of all CTP-VO. Overall CTA-VO sensitivity for the detection of EVT-VO was 69.9% and specificity was 95.3%. Among patients who received EVT, the rate of false negative CTA-VO was 30.1% (Tmax >6s: 69 (46–99.5) mL).Conclusion Systematically including CTP in acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.Data are available upon reasonable request. Not applicable.