Early Prediction of Irreversible Brain Damage after Ischemic Stroke at CT

Kummer, Rüdiger von; Bourquain, Holger; Bastianello, Stefano; Bozzao, L.; Manelfe, C.; Meier, Dieter; Hacke, Werner

doi:10.1148/radiology.219.1.r01ap0695

Cited by 310 publications

(191 citation statements)

References 30 publications

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“…Our results confirm the generally accepted notion that in acute cerebral ischemia, regions of hypoattenuation on noncontrast CT and CTA source images and hypoperfusion on CT perfusion CBV maps represent unsalvageable tissue despite reperfusion. 19,20 However, in the 3-hour window, CBV appears to be a significantly more sensitive and accurate marker for irreversible ischemic damage. We compared the mean ASPECTS of each CT-based technique and found no difference between the scores on noncontrast CT and CTA source images, but both were different from scores on CT perfusion CBV maps.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of the Alberta Stroke Program Early CT Score during the First 3 Hours of Middle Cerebral Artery Stroke: Comparison of Noncontrast CT, CT Angiography Source Images, and CT Perfusion

Lin¹,

Rapalino²,

Law³

et al. 2008

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Accuracy of the Alberta Stroke Program Early CT Score during the First 3 Hours of Middle Cerebral Artery Stroke: Comparison of Noncontrast CT, CT Angiography Source Images, and CT Perfusion

Lin¹,

Rapalino²,

Law³

et al. 2008

AJNR Am J Neuroradiol

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“…We defined hypodensity as a visible decrease in x-ray attenuation of brain tissue compared with the attenuation in other portions of the brain. 13 All patients or relatives gave informed consent before cerebral angiography and intra-arterial thrombolysis. Approval was granted by our institutional review board.…”

Section: Methodsmentioning

confidence: 99%

Contrast Enhancement and Contrast Extravasation on Computed Tomography After Intra-Arterial Thrombolysis in Patients With Acute Ischemic Stroke

Yoon

Seo

Kim

et al. 2004

Stroke

157

161

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Background and Purpose-The goal of this study was to determine the CT findings and clinical consequences of contrast enhancement and contrast extravasation on CT scans obtained after intra-arterial thrombolytic therapy for treatment of acute ischemic stroke. Methods-Sixty-two patients were treated with intra-arterial thrombolysis. All patients underwent nonenhanced CT scans immediately and 24 hours after thrombolytic therapy. Contrast enhancement was defined as a hyperdense lesion that disappeared on a 24-hour follow-up CT scan. Contrast extravasation was defined as a hyperdense lesion with maximum Hounsfield unit Ͼ90 that persisted on a follow-up CT scan. We evaluated the differences in the clinical and radiological data between 3 groups: contrast enhancement, contrast extravasation, and control groups. Results-Contrast enhancement was found in 14 of 62 patients (22.6%); contrast extravasation was seen in 7 (11.3%).Compared with the control group, the contrast enhancement group had a lower recanalization grade (64.3% versus 34.1%, Pϭ0.048) and a lower incidence of hemorrhagic transformation (14.3% versus 43.9%, Pϭ0.047). The contrast extravasation group had a higher incidence of both hemorrhage (100% versus 43.9%, Pϭ0.006) and symptomatic hemorrhage (100% versus 14.6%, PϽ0.001) than the control group. Poor outcomes were more frequent in the contrast extravasation group (100% versus 38.9%, Pϭ0.003) than the control group. Conclusions-Contrast enhancement on CT scans obtained after intra-arterial thrombolysis is usually not associated with hemorrhagic complications. However, contrast extravasation is highly associated with parenchymatous hematoma and should be considered a negative prognostic sign.

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“…Our data indicate that extensive early CT signs appear in about 64% of patients with large vessel occlusions, despite arriving at the hospital and undergoing brain CT imaging within 3 hours after onset. von Kummer et al reported early CT signs in 82% of patients within 6 hours of the onset of MCA ischemic stroke, and this group did not have a good prognosis over a 3-month follow-up period after r-tPA treatment [7][8][9] . In the European Cooperative Acute Stroke Study (ECASS), Larrue et al reported a high rate of the development of hemorrhagic infarction following r-tPA treatment in patients in whom early ischemic changes had already appeared within 6 hours of the onset of symptoms, indicating that the appearance of early CT signs more than 3 hours after onset may be an indicator of a lack of viability, and also suggesting a tendency toward hemorrhage after recanalization 10) .…”

Section: Discussionmentioning

confidence: 88%

Timing of the appearance of early hypodense computed tomography signs in patients with middle cerebral artery/internal carotid artery embolismion

Takahashi

Yamada

Shimizu

et al. 2010

Nihon Kyukyu Igakukai Zasshi

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Background: The appearance of extensive early computed tomography (CT) signs is considered as a contraindication for thrombolytic therapy. However, to date, no report has been published on the timing of the appearance of CT signs. We therefore investigated the time after onset until the appearance of early CT signs in patients with middle cerebral artery (MCA) trunk or common carotid artery (CCA)/internal carotid artery (ICA) embolisms. Methods: The time from onset until an initial CT scan, the subtypes of ischemic stroke and the appearance of early CT signs were investigated in early ischemic stroke patients with lesions of the CCA/ICA or MCA trunk who had been transported to our emergency and critical care center between 2002 and 2007. Results: A total of 104 patients (CCA/ICA, n=23; MCA trunk, n=81) were examined. The results indicated that the rate of the appearance of early CT signs was 0% at less than 0.5 hours after onset; on the other hand, the rate was 100% at 1.5-2 h and 2-3 h after outset. A significant difference in the timing of the initial CT brain scan (p<0.0001 Wilcoxon test) was seen between the group without early CT signs (n=37) and the group with early CT signs (n=67). The boundary line between the two groups apparently occurred 0.5-1.0 hours after the onset period. Thus, most early CT signs appeared 0.5-1.0 hours after onset (p<0.0001 Wilcoxon test). Conclusions: The present results could be useful when making decisions regarding the timing of thrombolytic therapy. (JJAAM. 2010; 21: 159-64)

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Early Prediction of Irreversible Brain Damage after Ischemic Stroke at CT

Abstract: After ischemic stroke, x-ray hypoattenuation at CT is highly specific for irreversible ischemic brain damage if detection occurs within the first 6 hours. Patients without hypoattenuating brain tissue have a more favorable clinical course.

Cited by 310 publications

References 30 publications

Accuracy of the Alberta Stroke Program Early CT Score during the First 3 Hours of Middle Cerebral Artery Stroke: Comparison of Noncontrast CT, CT Angiography Source Images, and CT Perfusion

Accuracy of the Alberta Stroke Program Early CT Score during the First 3 Hours of Middle Cerebral Artery Stroke: Comparison of Noncontrast CT, CT Angiography Source Images, and CT Perfusion

Contrast Enhancement and Contrast Extravasation on Computed Tomography After Intra-Arterial Thrombolysis in Patients With Acute Ischemic Stroke

Timing of the appearance of early hypodense computed tomography signs in patients with middle cerebral artery/internal carotid artery embolismion

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