Neurological deterioration and computed tomography perfusion changes with increased time to peak in lacunar stroke

Abstract

OBJECTIVES: Lacunar strokes can have fluctuations and progression in the acute period leading to poor outcomes. Our study sought to evaluate if, in lacunar strokes, neurological deterioration (ND) was associated with blood pressure (BP) variations, stroke size, or increased time to peak (TTP) on admission computed tomography perfusion (CTP). METHODS: Patients with lacunar stroke who had magnetic resonance imaging and CTP performed were enrolled in the study. ND was defined as ≥1-point worsening on a modified National Institutes of Health Stroke Scale (NIHSS) score or the Medical Research Council scale compared to baseline assessment. The difference in BP between the day of admission and the day of ND was calculated. Multivariate logistic regression analysis, adjusted for pertinent clinical and imaging covariates, was performed to determine predictors of ND. RESULTS: Among 409 patients screened, 49 were eligible for the study. There was no difference in age, gender, race, medical history, admission BP, and the modified NIHSS score between patients with and without ND. In unadjusted analysis, patients with ND tended to have increased TTP in the stroke area compared to the control (12 [63%] vs. 11 [37%], P = 0.07). On multivariate analysis adjusted for covariates, presence of an increased TTP on CTP was a predictor of ND (odds ratio [95% confidence interval] = 4.80 [1.15–20.10], P = 0.03). CONCLUSION: The presence of an increased TTP on CTP corresponding to the stroke lesion on diffusion-weighted imaging is a predictor of ND in patients with lacunar stroke. Larger studies are needed to confirm our findings.

CT Perfusion in Lacunar Stroke: A Systematic Review

“…The mean age ranges from 59.8 [6] to 72 years [16], with a women percentage ranging from 32 [14] to 53.1% [6], but with the half of studies ( 7) not reporting the information. In three studies [9,14,17], CTP was performed with a 16 rows scanner; in one study [17], a 40 rows scanner was used; in five studies [6,9,15,16,18], a 128 rows scanner was declared; in two studies [15,21], a 320 rows scanner was used allowing a whole brain perfusion approach and in one study [20] no technical detail was provided. A great variety of postprocessing software was reported, ranging from vendor machines tools [9,[16][17][18][19][23][24][25] to commercially available tools not related to individual vendor machines, such as Vitrea [21,21], RAPID [14], MIStar [15,23], F-STROKE [13].…”

“…In three studies [9,14,17], CTP was performed with a 16 rows scanner; in one study [17], a 40 rows scanner was used; in five studies [6,9,15,16,18], a 128 rows scanner was declared; in two studies [15,21], a 320 rows scanner was used allowing a whole brain perfusion approach and in one study [20] no technical detail was provided. A great variety of postprocessing software was reported, ranging from vendor machines tools [9,[16][17][18][19][23][24][25] to commercially available tools not related to individual vendor machines, such as Vitrea [21,21], RAPID [14], MIStar [15,23], F-STROKE [13]. However, most studies relied on visual assessment of the CTP maps and not on the automatic identification of hypoperfused areas.…”

“…The site of a lacunar stroke may affect the global accuracy of the CTP study (e.g., lesions outside the coverage volume of CTP, including infratentorial strokes). Some studies limited the evaluation to supratentorial strokes [13], but other studies considered infratentorial strokes, too [17,21]. The detection of infratentorial infarctions can be improved by assessing whole-brain CTP, but it remains a diagnostic challenge, and especially small volume infarctions in the brainstem are likely to be missed [25], being the sensitivity very low [28.1% (95% CI: 12.9; 53.4)].…”

No-reflow phenomenon following stroke recanalization therapy: Clinical assessment advances: A narrative review

“…[ 38 ] Even in cases of lacunar infarction, significant elongation of Tmax in the lesion area on DWI has been associated with neurological deterioration. [ 39 ] Consequently, a delay in Tmax after recanalization of thrombectomy vessels in ischemic stroke implies a substantial hypoperfusion area or the NRP. Some studies have used MRI to determine the final infarct volume, and the results indicated a strong correlation between delayed Tmax and large final infarct volume.…”

Effects of Tirofiban on Neurological Deterioration in Patients With Acute Ischemic Stroke

“…A cute ischemic stroke (AIS) is characterized by a sudden onset and quick peak of neurological deficits that often result in disability; however, from 5% to 40% of patients experience neurological deterioration (ND) after symptom onset, leading to worse outcomes and increased morbidity. [1][2][3] Ischemic stroke progression is the main cause of ND, especially during the first few days after stroke onset. 4,5 Antiplatelet therapy has been investigated to prevent early ND in patients with AIS.…”