Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke

Soltanolkotabi, Maryam; Honarmand, A; Bernstein, Richard A.; Lee, V. H.; Conners, James; Dehkordi-Vakil, Farideh; Shaibani, Ali; Hurley, Michael C.; Ansari, Sameer A.

doi:10.3174/ajnr.a3889

Cited by 24 publications

(23 citation statements)

References 34 publications

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“…7,8 Several studies support the concept of using CTP as a tool for clinical decision-making for patients with AIS for IAT. [9][10][11][12][13] However, its clinical value has not been established because of limitations in these studies, such as retrospective design, lack of controls, and small cohort sizes. The MR RESCUE trial was the first to investigate the value of perfusion imaging-based selection for IAT, but was hampered by small cohort size and the use of less effective stroke devices.…”

Section: Strokementioning

confidence: 99%

Value of Computed Tomographic Perfusion–Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment

Borst¹,

Berkhemer²,

Roos³

et al. 2015

Stroke

103

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Background and Purpose— The utility of computed tomographic perfusion (CTP)–based patient selection for intra-arterial treatment of acute ischemic stroke has not been proven in randomized trials and requires further study in a cohort that was not selected based on CTP. Our objective was to study the relationship between CTP-derived parameters and outcome and treatment effect in patients with acute ischemic stroke because of a proximal intracranial arterial occlusion. Methods— We included 175 patients who underwent CTP in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN). Association of CTP-derived parameters (ischemic-core volume, penumbra volume, and percentage ischemic core) with outcome was estimated with multivariable ordinal logistic regression as an adjusted odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale. Interaction between CTP-derived parameters and treatment effect was determined using multivariable ordinal logistic regression. Interaction with treatment effect was also tested for mismatch (core <70 mL; penumbra core >1.2; penumbra core >10 mL). Results— The adjusted odds ratio for improved functional outcome for ischemic core, percentage ischemic core, and penumbra were 0.79 per 10 mL (95% confidence interval: 0.71–0.89; P <0.001), 0.82 per 10% (95% confidence interval: 0.66–0.90; P =0.002), and 0.97 per 10 mL (96% confidence interval: 0.92–1.01; P =0.15), respectively. No significant interaction between any of the CTP-derived parameters and treatment effect was observed. We observed no significant interaction between mismatch and treatment effect. Conclusions— CTP seems useful for predicting functional outcome, but cannot reliably identify patients who will not benefit from intra-arterial therapy.

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Section: Strokementioning

confidence: 99%

Value of Computed Tomographic Perfusion–Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment

Borst¹,

Berkhemer²,

Roos³

et al. 2015

Stroke

103

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“…Patients without rt-PA were inherently biased towards a later time to treatment due to the prompt time windows for thrombolysis. Similar outcomes may reflect an improvement in patient selection for endovascular therapy and the ability of modern imaging criteria, including perfusion based mismatch and the presence of pial collaterals, to identify patients beyond the traditional time windows that would benefit from intervention 28 29…”

Section: Discussionmentioning

confidence: 90%

Trends in mortality following mechanical thrombectomy for the treatment of acute ischemic stroke in the USA

Villwock

Padalino

Deshaies

2015

J NeuroIntervent Surg

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Utilization of MT represents a small percentage of stroke cases, although the trend is increasing. Mortality following MT has been showing a steady decline over the past 5 years. This may be a result of a learning curve, improved patient selection, and/or device improvements. Randomized trials remain essential to evaluate the potential benefit of endovascular devices and identify the most appropriate patients.

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“…In addition, CTP seems to be able to differentiate between infarct core and ischemic penumbra as, according to the classical ‘penumbral hypothesis’, areas with low CBV and low CBF or high MTT (CBF or MTT/CBV match) correspond to the core, while those with normal CBV and low CBF or high MTT (CBF or MTT/CBV mismatch) refer to the penumbra 23 24. Although this assumption has been challenged by the demonstration that CBF better approximates the extent of the infarct core than CBV,25 the potential of the MTT/CBV mismatch model in the selection of patients for reperfusion therapies was recently confirmed 26…”

Section: Discussionmentioning

confidence: 99%

CT perfusion and angiographic assessment of pial collateral reperfusion in acute ischemic stroke: the CAPRI study

Consoli

Andersson

Holmberg

et al. 2016

J NeuroIntervent Surg

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Perfusion-Based Selection for Endovascular Reperfusion Therapy in Anterior Circulation Acute Ischemic Stroke

Cited by 24 publications

References 34 publications

Value of Computed Tomographic Perfusion–Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment

Value of Computed Tomographic Perfusion–Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment

Trends in mortality following mechanical thrombectomy for the treatment of acute ischemic stroke in the USA

CT perfusion and angiographic assessment of pial collateral reperfusion in acute ischemic stroke: the CAPRI study

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