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Computed tomography perfusion-based selection of endovascularly treated acute ischaemic stroke patients - Are there lessons to be learned from the pre-evidence era?

Abstract Introduction Some of the latest groundbreaking trials suggest that noncontrast cranial computed tomography and computed tomography-angiography are sufficient tools for patient selection within six hours of symptom onset. Before endovascular stroke therapy became the standard of care, patient selection was one of the most useful tools to avoid futile reperfusions. We report the outcomes of endovascularly treated stroke patients selected with a perfusion-based paradigm and discuss the implications in the current era of endovascular treatment. Material and methods After an interdisciplinary meeting in September 2012 we agreed to select thrombectomy candidates primarily based on computed tomography perfusion with a cerebral blood volume Alberta Stroke Program Early Computed Tomography Scale (CBV-ASPECTS) of <7 being a strong indicator of futile reperfusion. In this study, we retrospectively screened all patients with an M1 thrombosis in our neurointerventional database between September 2012 and December 2014. Results In 39 patients with a mean age of 69 years and a median admission National Institute of Health Stroke Scale of 17 the successful reperfusion rate was 74% and the favourable outcome rate at 90 days was 56%. Compared to previously published data from our database 2007-2011, we found that a two-point increase in median CBV-ASPECTS was associated with a significant increase in favourable outcomes. Conclusion Computed tomography perfusion imaging as an additional selection criterion significantly increased the rate of favourable clinical outcome in patients treated with mechanical thrombectomy. Although computed tomography perfusion has lost impact within the six-hour period, we still use it in cases beyond six hours as a means to broaden the therapeutic window.
PMID
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Authors

Mayor MeshTerms
Keywords

CBV-ASPECTS

mechanical thrombectomy

penumbra

reperfusion

stroke time-window

Journal Title the neuroradiology journal
Publication Year Start




PMID- 28424017
OWN - NLM
STAT- In-Process
DA  - 20170420
LR  - 20170420
IS  - 2385-1996 (Electronic)
IS  - 1971-4009 (Linking)
VI  - 30
IP  - 2
DP  - 2017 Apr
TI  - Computed tomography perfusion-based selection of endovascularly treated acute
      ischaemic stroke patients - Are there lessons to be learned from the pre-evidence
      era?
PG  - 138-143
LID - 10.1177/1971400916689372 [doi]
AB  - Introduction Some of the latest groundbreaking trials suggest that noncontrast
      cranial computed tomography and computed tomography-angiography are sufficient
      tools for patient selection within six hours of symptom onset. Before
      endovascular stroke therapy became the standard of care, patient selection was
      one of the most useful tools to avoid futile reperfusions. We report the outcomes
      of endovascularly treated stroke patients selected with a perfusion-based
      paradigm and discuss the implications in the current era of endovascular
      treatment. Material and methods After an interdisciplinary meeting in September
      2012 we agreed to select thrombectomy candidates primarily based on computed
      tomography perfusion with a cerebral blood volume Alberta Stroke Program Early
      Computed Tomography Scale (CBV-ASPECTS) of &lt;7 being a strong indicator of futile 
      reperfusion. In this study, we retrospectively screened all patients with an M1
      thrombosis in our neurointerventional database between September 2012 and
      December 2014. Results In 39 patients with a mean age of 69 years and a median
      admission National Institute of Health Stroke Scale of 17 the successful
      reperfusion rate was 74% and the favourable outcome rate at 90 days was 56%.
      Compared to previously published data from our database 2007-2011, we found that 
      a two-point increase in median CBV-ASPECTS was associated with a significant
      increase in favourable outcomes. Conclusion Computed tomography perfusion imaging
      as an additional selection criterion significantly increased the rate of
      favourable clinical outcome in patients treated with mechanical thrombectomy.
      Although computed tomography perfusion has lost impact within the six-hour
      period, we still use it in cases beyond six hours as a means to broaden the
      therapeutic window.
FAU - Psychogios, Marios-Nikos
AU  - Psychogios MN
AD  - 1 Department of Neuroradiology, Georg-August University Goettingen, Germany.
FAU - Knauth, Michael
AU  - Knauth M
AD  - 1 Department of Neuroradiology, Georg-August University Goettingen, Germany.
FAU - Bshara, Raya
AU  - Bshara R
AD  - 1 Department of Neuroradiology, Georg-August University Goettingen, Germany.
FAU - Schregel, Katharina
AU  - Schregel K
AD  - 1 Department of Neuroradiology, Georg-August University Goettingen, Germany.
FAU - Tsogkas, Ioannis
AU  - Tsogkas I
AD  - 1 Department of Neuroradiology, Georg-August University Goettingen, Germany.
FAU - Papageorgiou, Ismini
AU  - Papageorgiou I
AD  - 1 Department of Neuroradiology, Georg-August University Goettingen, Germany.
AD  - 3 Institute of Radiology, Suedharz Hospital Nordhausen non-profit LTD, Germany.
FAU - Maier, Ilko
AU  - Maier I
AD  - 2 Department of Neurology, Georg-August University Goettingen, Germany.
FAU - Liman, Jan
AU  - Liman J
AD  - 2 Department of Neurology, Georg-August University Goettingen, Germany.
FAU - Behme, Daniel
AU  - Behme D
AD  - 1 Department of Neuroradiology, Georg-August University Goettingen, Germany.
LA  - eng
PT  - Journal Article
DEP - 20170101
PL  - United States
TA  - Neuroradiol J
JT  - The neuroradiology journal
JID - 101295103
OTO - NOTNLM
OT  - CBV-ASPECTS
OT  - mechanical thrombectomy
OT  - penumbra
OT  - reperfusion
OT  - stroke time-window
EDAT- 2017/04/21 06:00
MHDA- 2017/04/21 06:00
CRDT- 2017/04/21 06:00
AID - 10.1177/1971400916689372 [doi]
PST - ppublish
SO  - Neuroradiol J. 2017 Apr;30(2):138-143. doi: 10.1177/1971400916689372. Epub 2017
      Jan 1.

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