Multimodal Computed Tomography Based Definition of Cerebral Imaging Profiles for Acute Stroke Reperfusion Therapy (CT-DEFINE): Results of a Prospective Observational Study

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

Abstract

PURPOSE: To prospectively evaluate the prognostic impact of multimodal computed tomography-based imaging in ischemic stroke patients potentially eligible for reperfusion therapy.

METHODS: Anterior circulation stroke patients underwent non-contrast CT (NCCT), CT-angiography, and CT-perfusion within 12 h from symptom-onset. Patients could be treated with intravenous-tissue plasminogen activator (IV-tPA), endovascular or combined reperfusion therapies. Cerebral imaging profiles (IP) were NCCT-Alberta Stroke Program Early CT Score (ASPECTS) > 7 (IP1); NCCT-ASPECTS > 5 and proximal occlusion on CT-angiography (IP2); CT-perfusion mismatch between cerebral blood volume (CBV)-ASPECTS, and cerebral blood flow (CBF)-ASPECTS ≥ 2 (IP3). Favorable outcome was defined as modified Rankin Scale ≤ 2 at 3 months.

RESULTS: Of 102 included patients, 62 (61%) received any reperfusion therapy. In IP2 and IP3, favorable outcome was more frequent in patients with reperfusion therapy than in those without; however, this did not reach statistical significance (IP2: 39% vs 15%, p = 0.26; IP3: 50% vs 17 %; p = 0.31). No difference was seen in IP1 (58% vs 58%, p = 1.0). In IP2, patients with IV-tPA alone achieved better functional outcome (50% vs 11%, p = 0.03) and lower mortality (0% vs 28%, p = 0.045) than those without.

CONCLUSIONS: Our results suggest a benefit with imaging profile selection based upon the combination of a small-to-moderate-sized infarction and a visible intracranial occlusion in patients receiving IV-tPA. Reperfusion therapy may be futile in patients without proven vessel occlusion.

Details

OriginalspracheEnglisch
Seiten (von - bis)403-410
Seitenumfang8
FachzeitschriftClinical neuroradiology
Jahrgang25
Ausgabenummer4
PublikationsstatusVeröffentlicht - Dez. 2015
Peer-Review-StatusJa

Externe IDs

Scopus 84948740297
ORCID /0000-0001-7465-8700/work/151436653

Schlagworte

Schlagwörter

  • Aged, Cerebral Angiography/methods, Female, Fibrinolytic Agents/administration & dosage, Humans, Injections, Intravenous, Male, Multimodal Imaging/methods, Prognosis, Prospective Studies, Reperfusion/methods, Reproducibility of Results, Sensitivity and Specificity, Stroke/diagnostic imaging, Tissue Plasminogen Activator/administration & dosage, Tomography, X-Ray Computed/methods, Treatment Outcome