Clinical/perfusion CT CBV mismatch as prognostic factor in intraarterial thrombectomy in acute anterior circulation stroke

Clin Neurol Neurosurg. 2014 Jun;121:39-45. doi: 10.1016/j.clineuro.2014.03.007. Epub 2014 Mar 15.

Abstract

Objective: Contradictory results were reported for the outcome after endovascular recanalization (ERT) in acute anterior circulation ischemic stroke. We assessed whether a clinical/perfusion CT cerebral blood volume (CBV) mismatch concept (CPM) can identify patients who will benefit from reperfusion therapy.

Methods: Imaging and clinical data of 58 consecutive ERT cases with acute anterior circulation stroke (ICA, M1, proximal M2) undergoing intraarterial thrombectomy within 4.5h after symptom onset were analyzed retrospectively. CPM was defined as NIHSS≥8 and PCT CBV ASPECTS≥7. Minor CBV lesion was defined as PCT CBV ASPECTS≥7.

Results: All baseline characteristics other than blood glucose did not differ between the paired groups. Revascularization was achieved in 87.9% of all patients without significant difference between the paired groups. Favorable clinical outcome after 3 months (mRS≤2) resulted in 29.3% of all patients, in contrast to 47.4% of the CPM positive and 52.2% of the minor CBV lesion groups.

Conclusion: CPM can identify patients who will benefit from reperfusion therapy in acute anterior circulation ischemic stroke.

Keywords: CT; Cerebral blood volume; Mismatch; Perfusion; Stroke; Thrombectomy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Volume / physiology
  • Brain / blood supply
  • Brain / pathology*
  • Brain Ischemia / drug therapy*
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Male
  • Middle Aged
  • Perfusion / methods
  • Retrospective Studies
  • Stroke / drug therapy*
  • Thrombectomy / methods
  • Thrombolytic Therapy* / methods
  • Treatment Outcome