Journal
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
Volume 31, Issue 1, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106208
Keywords
Acute ischemic stroke; Collateral circulation; Perfusion imaging; Thrombectomy
Categories
Funding
- National Institutes of Health NINDS (National Institute of Neurological Disorders and Stroke) [U10NS086487, U01NS092076]
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Perfusion imaging collateral profiles can predict infarct growth in late presenting, non-reperfused ischemic stroke patients, aiding in clinical decision-making and identifying patients' prognosis.
Objective: This study evaluated the associations of perfusion imaging collateral profiles with radiographic and clinical outcome in late presenting, non-reperfused patients in the DEFUSE 3 clinical trial. Methods: Non-reperfused patients in both treatment arms were included. Baseline ischemic core, Tmax >6s, and Tmax >10s perfusion volumes were calculated with RAPID software; infarct volumes obtained 24 hours after randomization were manually determined from DWI or CT. Substantial infarct growth was defined as a >25mL increase between baseline and 24-hour follow-up. Hypoperfusion Intensity Ratio (HIR) was defined as the proportion of the Tmax >6s lesion with Tmax >10s delay; CBV index was calculated by RAPID from mean CBV values within the Tmax >6s lesion compared to regions of normal CBV. Results: Eighty-four patients were included. ROC analysis showed HIR >0.34 (AUC=0.68) and CBV index <0.74 (AUC=0.72) optimally predicted substantial infarct growth in follow-up. Median growth was 23.4 versus 73.2mL with HIR threshold of 0.34 (p=0.005), and 24.3 versus 58.7mL with CBV index threshold of 0.74 (p=0.004). If baseline HIR and CBV index were both favorable, median growth was 21.7mL, 40.9mL if one was favorable, and 108.2mL if both were unfavorable (p<0.001). Baseline perfusion profile was not associated with 90-day functional outcome. Conclusions: Perfusion collateral scores forecast infarct growth in late presenting, non-reperfused ischemic stroke patients. These parameters may be useful for guiding transfer decisions, such as need for repeat imaging upon thrombectomy center arrival, and may help identify slow progressing patients more likely to have persistent salvageable ischemic tissue beyond 24 hours.
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