Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:

Lev, Michael H.; Segal, Alan Z.; Farkas, Jeffrey; Hossain, Sabera; Putman, Christopher M.; Hunter, George J.; Budzik, Ronald F; Harris, Gordon J.; Buonanno, Ferdinando S.; Ezzeddine, Mustapha A.; Chang, Yuchiao; Koroshetz, Walter J.; González, Ramón; Schwamm, Lee H

doi:10.1161/hs0901.095680

Cited by 285 publications

(196 citation statements)

References 34 publications

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“…Significant correlation was identified between the infarct sizes on the admission perfusion CT and on the delayed DWI-MR, in agreement with a previous report of patients with documented recanalization during intra-arterial thrombolysis. 53 Two objections could be raised to our study proto-col. First, the four examined cerebral slices were not exactly the same in the perfusion CT and DWI-MR, as there was an interval of several days between the two examinations. However, for each patient, we performed an averaging of the ischemic areas calculated on four adjacent slices, thus decreasing the inaccuracy due to the same slices not being used.…”

Section: Correlation Between Admission Perfusion Computed Tomography mentioning

confidence: 99%

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

Wintermark¹,

Reichhart²,

Thiran

et al. 2002

Annals of Neurology

462

283

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The purpose of this study was to determine the prognostic accuracy of perfusion computed tomography (CT), performed at the time of emergency room admission, in acute stroke patients. Accuracy was determined by comparison of perfusion CT with delayed magnetic resonance (MR) and by monitoring the evolution of each patient's clinical condition. Twentytwo acute stroke patients underwent perfusion CT covering four contiguous 10mm slices on admission, as well as delayed MR, performed after a median interval of 3 days after emergency room admission. Eight were treated with thrombolytic agents. Infarct size on the admission perfusion CT was compared with that on the delayed diffusion-weighted (DWI)-MR, chosen as the gold standard. Delayed magnetic resonance angiography and perfusion-weighted MR were used to detect recanalization. A potential recuperation ratio, defined as PRR ‫؍‬ penumbra size/(penumbra size ؉ infarct size) on the admission perfusion CT, was compared with the evolution in each patient's clinical condition, defined by the National Institutes of Health Stroke Scale (NIHSS). In the 8 cases with arterial recanalization, the size of the cerebral infarct on the delayed DWI-MR was larger than or equal to that of the infarct on the admission perfusion CT, but smaller than or equal to that of the ischemic lesion on the admission perfusion CT; and the observed improvement in the NIHSS correlated with the PRR (correlation coefficient ‫؍‬ 0.833). In the 14 cases with persistent arterial occlusion, infarct size on the delayed DWI-MR correlated with ischemic lesion size on the admission perfusion CT (r ‫؍‬ 0.958). In all 22 patients, the admission NIHSS correlated with the size of the ischemic area on the admission perfusion CT (r ‫؍‬ 0.627). Based on these findings, we conclude that perfusion CT allows the accurate prediction of the final infarct size and the evaluation of clinical prognosis for acute stroke patients at the time of emergency evaluation. It may also provide information about the extent of the penumbra. Perfusion CT could therefore be a valuable tool in the early management of acute stroke patients.

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Section: Correlation Between Admission Perfusion Computed Tomography mentioning

confidence: 99%

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

Wintermark¹,

Reichhart²,

Thiran

et al. 2002

Annals of Neurology

462

283

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“…5,6 CT angiography (CTA) is increasingly performed and can be rapidly obtained with minimal delay after NCCT. 7,8 Areas of hypoattenuation on CTA source images (CTASI) delineate regions of brain tissue with ischemic damage. 8,9 Applied on the Alberta Stroke Program Early CT Score (ASPECTS), CTASI has improved the prediction of final infarct size and clinical outcome compared to NCCT.…”

mentioning

confidence: 99%

Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion

Puetz

Sylaja²,

Coutts³

et al. 2008

Stroke

366

304

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Background and Purpose-Quantification of early ischemic changes (EIC) may predict functional outcome in patients with basilar artery occlusion (BAO). We tested the validity of a novel CT score, the posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS). Methods-Pc-ASPECTS allots the posterior circulation 10 points. Two points each are subtracted for EIC in midbrain or pons and 1 point each for EIC in left or right thalamus, cerebellum or PCA-territory, respectively. We studied 2 different populations: (1) patients with suspected vertebrobasilar ischemia and (2) patients with BAO. We applied pc-ASPECTS to noncontrast CT (NCCT), CT angiography source images (CTASI), and follow-up image by 3-reader consensus. We calculated sensitivity for ischemic changes and analyzed the predictivity of pc-ASPECTS for independent (modified Rankin Scale [mRS] score Յ2) and favorable (mRS score Յ3) outcome. Results-Of 130 patients with suspected vertebrobasilar ischemia, 72% (94) had posterior circulation stroke, 8% (10) transient ischemic attack, and 20% (26)

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“…Exploratory analysis showed a significant relationship between the level of diastolic blood pressure reduction and outcome. Irrespective of treatment group, the odds of death or dependency at 21 days was 2.60 (95% CI: 0.82, 8,27) for those with a Ͻ10% early decrease in diastolic blood pressure, 2.97 (95% CI: 1.16, 7.63) for those with a 10% to 20% decrease, and 4.36 (95% CI: 1.63, 11.7) for those with a Ն20% decrease. 46 The effect was only present in those without a total anterior circulation distribution infarction.…”

Section: Discussionmentioning

confidence: 95%

“…[23][24][25] In contrast to MRI-based techniques that are limited to relative measures of cerebral perfusion, dynamic CT scan methods can give absolute perfusion levels that reflect ischemic, but potentially salvageable, tissue. 26,27 The combination of the possible presence of brain tissue that is ischemic, but not infracted, and an impaired autoregulatory response provides a major argument against lowering systemic blood pressure in patients with acute ischemic stroke. In the zone of ischemia, CBF will be reduced with reductions in MAP, potentially below the threshold of viability.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Management in Patients With Acute Ischemic Stroke

Goldstein

2004

Hypertension

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A 68-year-old right-hand-dominant man was brought to the hospital because of a speech disturbance and right arm and leg weakness. He awoke with these deficits and was last known to be symptom-free when retiring to bed the previous evening 8 hours earlier. His past medical history was notable for coronary heart disease, the patient having underwent coronary artery bypass surgery 7 years previously for unstable angina, but he had no known history of myocardial infarction. He also had hypertension and hyperlipidemia, and smoked 1 pack of cigarettes daily for more than 40 years. He had no history of calf claudication. His hypertension was being treated with a diuretic and ␤-adrenergic receptor blocker. He was also prescribed 325 mg of aspirin daily and an HMG CoA-reductase inhibitor (statin); however, his wife remarked that he often forgot to take his medications. His last total cholesterol was 240 mg/dL, with LDL cholesterol of 130 mg/dL. He had a strong family history of coronary heart disease after the age of 50. He had no known drug allergies. Physical ExaminationThe patient's blood pressure was 195/100 mm Hg in both arms, with a regular pulse of 90 bpm. His weight was 225 lb (body mass index: 31.4 kg/m 2 ). His lungs were clear to auscultation. Cardiac examination showed a laterally displaced point of maximum impulse with an S 4 gallop and a soft nonradiating systolic murmur at the base. His abdomen was obese without organomegaly and no abdominal bruits were detected. He had no rashes and no joint deformities. The left superficial temporal artery pulse was stronger than the right. There were soft bilateral anterior cervical bruits, left louder than right, but no supraclavicular bruits. There were bilateral femoral bruits. Radial pulses were 2 ϩ and symmetric. Dorsalis pedis and posterior tibial pulses were 1 ϩ . There was no pretibial or ankle edema. Neurological ExaminationThe patient was alert. He spoke haltingly and made frequent paraphasic errors, using inappropriate words and occasional neologisms. He was able to follow simple verbal commands but had difficulty with repetitions. Further cognitive evaluation could not be performed because of the language disturbance. Cranial nerve examination revealed a right homonymous visual field deficit to threat. Funduscopic examination disclosed arteriolar narrowing with arteriolar-venous nicking, but no hemorrhages. There were no Hollenhorst plaques. There was a left gaze preference with otherwise full extraocular movements and no nystagmus. Pupillary light reflexes were normal. The right corneal response was diminished and there was a mild right lower facial paresis. His gag response was absent and his tongue deviated to the right. Motor examination revealed normal bulk with diminished tone in his right arm. He had 3/5 proximal and 2/5 distal strength in the right arm, 4/5 strength in the right leg, and full strength in his left arm and leg. He had a coordination deficit consistent with the weakness in his right arm and leg and normal coordination on the left. Senso...

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Utility of Perfusion-Weighted CT Imaging in Acute Middle Cerebral Artery Stroke Treated With Intra-Arterial Thrombolysis:

Cited by 285 publications

References 34 publications

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion

Blood Pressure Management in Patients With Acute Ischemic Stroke

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