Usefulness of Triphasic Perfusion Computed Tomography for Intravenous Thrombolysis With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

Lee, Kwang Ho; Lee, Soo Joo; Cho, Soo-Jin; Na, Dong Gyu; Byun, Hong Sik; Kim, Yong-Beom; Song, Hee-Jeong; Jin, In-Seon; Chung, Chin‐Sang

doi:10.1001/archneur.57.7.1000

Cited by 39 publications

(24 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A triphasic helical CT-based study previously demonstrated that the maximal enhancement in a nonoccluded artery was observed around 30 s after contrast material administration, followed by a decrease in contrast enhancement to half, then a plateau up to 60–180 s in ischemic stroke patients within 6 h after symptom onset [19]. Moreover, other studies using multiphasic contrast CT have shown that, compared with the arterial phase, the delayed phase showed a higher correlation with collateral circulation acquired by 4-vessel angiography [20,21]. Thus, contrast dye on CECT is at a more distal location compared with that in CTA-SI.…”

Section: Discussionmentioning

confidence: 99%

“…This logically explains the use of collateral circulation as a prognostic factor in acute ischemic stroke and, thus, the presence of collateral circulation predicts improved outcome in patients with MCA occlusive stroke [1,25,26]. In addition, reduced collateral circulation has been shown to increase the rate of mortality and hemorrhagic transformation [21,27,28]. Our study reaffirmed that patients with fair pial collateral circulation have a less severe symptomatic hemorrhage and a better prognosis than patients with bad pial collateral circulation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Conventional Enhancement CT: A Valuable Tool for Evaluating Pial Collateral Flow in Acute Ischemic Stroke

Choi

Kim²,

Hong³

et al. 2011

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: To establish an easy and rapid method for evaluating pial collateral flow, we compared the Alberta Stroke Program Early CT Score (ASPECTS) on nonenhanced CT (NECT), conventional contrast-enhanced CT (CECT), and CT angiography source images (CTA-SI) in patients with acute ischemic stroke. Methods: We reviewed 55 consecutive patients with acute ischemic stroke involving the anterior circulation who underwent thrombolysis within 6 h of referral to the stroke center. We evaluated axial images using NECT, CECT and CTA-SI. Pial collateral formation was graded as fair (1–2 points) or bad (3–5 points) based on 4-vessel angiography. The outcomes were dichotomized into good (modified Rankin Scale, mRS 0–2) or poor (mRS 3–6) using a 90-day mRS. Results: Demographics (age, sex, initial National Institutes of Health Stroke Scale score, time to CT acquisition and stroke subtypes) did not significantly differ between patients with fair or bad collateral formation. ASPECTS on CECT (r = –0.788, p < 0.0001) was more inversely correlated with pial collateral formation than ASPECTS on NECT (r = –0.557, p < 0.0001) or ASPECTS on CTA-SI (r = –0.662, p < 0.0001). Furthermore, ASPECTS on CECT demonstrated a high discriminative capability, with an area under the receiver operating characteristic curve of 0.885 for fair collateral circulation, compared to 0.790 for ASPECTS on NECT and 0.794 for ASPECTS on CTA-SI. Multiple regression analysis revealed that ASPECTS on CECT (≧8) was an independent predictor for fair collateral circulation (odds ratio = 23.00, p < 0.001) and a good prognosis (odds ratio = 17.81, p < 0.001). Conclusion: ASPECTS on CECT is a feasible method for predicting pial collateral flow and overall outcomes in acute ischemic stroke.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Conventional Enhancement CT: A Valuable Tool for Evaluating Pial Collateral Flow in Acute Ischemic Stroke

Choi

Kim²,

Hong³

et al. 2011

Cerebrovasc Dis

View full text Add to dashboard Cite

show abstract

“…Many patients presenting less than 8 hours from symptom onset clearly do not have salvageable brain because of poor collaterals. 25 If good, rapid imaging capable of identifying ischemic penumbra were available to determine salvageable brain tissue (such as diffusion-weighted or perfusion-weighted MR imaging [26][27][28][29][30][31][32][33][34][35][36] or CT perfusion 37,38 ), intra-arterial interventions for ischemic stroke could be reduced by perhaps half because it would be possible to determine that infarction is complete before these patients are moved to an interventional suite. This would be of benefit to patients because it spares them futile, aggressive interventions.…”

Section: Who Needs Intra-arterial Ischemic Stroke Therapy?mentioning

confidence: 99%

Intra-Arterial Stroke Therapy: An Assessment of Demand and Available Work Force

Cloft

Rabinstein²,

Lanzino³

et al. 2009

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

SUMMARY: Intra-arterial therapy is currently applicable to a small subset of patients with ischemic stroke, but it will likely have an expanding role as new devices are introduced. This review evaluates the demand for such therapy and the physician work force available to provide such therapy in the United States. The available literature was reviewed to assess how many patients might need intra-arterial therapy annually and how many skilled neurointerventionalists are available to provide intra-arterial therapy for acute stroke. The number of acute ischemic strokes in the United States that will be amenable to intra-arterial therapy can only be crudely estimated, but it is certainly less than 126,000 per year and will quite likely be no more than 20,000 cases per year. The future demand for intra-arterial reperfusion techniques may change, but the number of patients who require intra-arterial thrombolysis is currently quite low. The overall number of neurointerventionists is currently adequate, though there might be local shortages.

show abstract

“…In the field of acute stroke, MPCT has been used as a prediction tool for final infarct volume, infarct growth, subsequent brain edema, and clinical response after thrombolysis [3,6,7]. Previously, we reported that MPCT could also be used in assessing perfusion deficit and collateral circulation as reliably as DSA in a small number of patients [8].…”

Section: Discussionmentioning

confidence: 99%

Multiphasic Perfusion Computed Tomography as a Predictor of Collateral Flow in Acute Ischemic Stroke: Comparison with Digital Subtraction Angiography

et al. 2012

Self Cite

View full text Add to dashboard Cite

Background: Assessing collateral status is important in acute ischemic stroke. The purpose of this study was to compare multiphasic perfusion computed tomography (MPCT) with digital subtraction angiography (DSA) in predicting leptomeningeal collateral flow in acute middle cerebral artery (MCA) infarction. Methods: Consecutive patients underwent MPCT and DSA for acute MCA infarction that presented within 6 h of symptom onset. We included patients who showed MCA occlusion in the same location on both modalities and assessed the agreement rate and correlation between the MPCT and DSA collateral grades. Results: Of 54 patients, 44 (81.5%) had proximal MCA (M1) occlusions and 10 (18.5%) had distal MCA (M2) occlusions based on MPCT and DSA. The ĸ-coefficients were 0.87 and 0.81 in the MPCT and DSA collateral grade systems, respectively. Forty-four patients (81.5%) belonged to the same category in both collateral-grading systems. MPCT collateral grades correlated positively with those of DSA (Spearman’s correlation coefficient 0.827, p < 0.001). Conclusion: Our data show that MPCT can predict leptomeningeal collateral flow in acute ischemic stroke. Based on collateral status assessed by MPCT, different therapeutic approaches might be warranted.

show abstract

Usefulness of Triphasic Perfusion Computed Tomography for Intravenous Thrombolysis With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

Abstract: Thrombolysis can be safely performed within 3 or 7 hours of stroke onset according to the extent of severe perfusion deficit on TPCT. A larger extent of moderate perfusion deficit on TPCT may predict early improvement after thrombolysis.

Cited by 39 publications

References 25 publications

Conventional Enhancement CT: A Valuable Tool for Evaluating Pial Collateral Flow in Acute Ischemic Stroke

Conventional Enhancement CT: A Valuable Tool for Evaluating Pial Collateral Flow in Acute Ischemic Stroke

Intra-Arterial Stroke Therapy: An Assessment of Demand and Available Work Force

Multiphasic Perfusion Computed Tomography as a Predictor of Collateral Flow in Acute Ischemic Stroke: Comparison with Digital Subtraction Angiography

Contact Info

Product

Resources

About