scholarly journals Multimodal Computed Tomography in Acute Ischaemic Stroke

2011 ◽  
Vol 6 (2) ◽  
pp. 101
Author(s):  
Sachin Rastogi ◽  
David S Liebeskind ◽  
◽  
Keyword(s):  
Computed Tomography ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Ct Perfusion ◽  
Vascular Occlusion ◽  
Vascular Pathology ◽  
Stroke Patients ◽  
Infarct Core ◽  
Head Ct ◽  
Ct Angiogram

Stroke is the third leading cause of death in the US, affecting 795,000 individuals annually. Currently, only a small percentage of acute stroke patients receive thrombolytic treatment. A significant limitation is the current use of strict time criteria in the decision to treat. As there are significant inter-individual variations in response to an acute vascular occlusion, the goal of modern imaging such as multimodal computed tomography (CT) is to rapidly identify acute ischaemic stroke patients and determine which patients are likely to benefit from treatment based on tissue perfusion status rather than time of presentation alone. Multimodal CT consists of a non-contrast head CT, CT angiogram (CTA) of the head and neck, and CT perfusion (CTP). The non-contrast head CT allows rapid triage of a patient with haemorrhagic versus ischaemic stroke. The CTA allows identification of the site of vascular pathology with similar quality to digital subtraction angiography. The CTP scan allows for determination of the infarct core and surrounding ischaemic penumbra, which remains at risk for infarction if perfusion is not restored. This allows the potential to prospectively treat only those patients likely to benefit from thrombolysis while protecting those patients unlikely to benefit from the risks associated with treatment.

scholarly journals Multimodal Computed Tomography in Acute Ischemic Stroke

US Neurology ◽  
2010 ◽  
Vol 06 (01) ◽  
pp. 50 ◽  
Author(s):  
Sachin Rastogi ◽  
David S Liebeskind ◽  
◽  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Vascular Occlusion ◽  
Vascular Pathology ◽  
Stroke Patients ◽  
Infarct Core ◽  
Head Ct ◽  
Ct Angiogram

Stroke is the third leading cause of death in the US, affecting 795,000 individuals annually. Currently, only a small percentage of acute stroke patients receive thrombolytic treatment. A significant limitation is the current use of strict time criteria in the decision to treat. As there are significant interindividual variations in response to an acute vascular occlusion, the goal of modern imaging such as multimodal computed tomography (CT) is to rapidly identify acute ischemic stroke patients and determine which patients are likely to benefit from treatment based on tissue perfusion status rather than time of presentation alone. Multimodal CT consists of a non-contrast head CT, CT angiogram (CTA) of the head and neck, and CT perfusion (CTP). The non-contrast head CT allows rapid triage of a patient with hemorrhagic versus ischemic stroke. The CTA allows identification of the site of vascular pathology with similar quality to digital subtraction angiography. The CTP scan allows for determination of the infarct core and surrounding ischemic penumbra, which remains at risk for infarction if perfusion is not restored. This allows the potential to prospectively treat only those patients likely to benefit from thrombolysis while protecting those patients unlikely to benefit from the risks associated with treatment.

scholarly journals Outcome estimation based on multimodal computed tomography examination in acute ischaemic stroke patients treated with mechanical thrombectomy

2019 ◽  
Vol 14 (4) ◽  
pp. 560-566
Author(s):  
Bartłomiej Łasocha ◽  
Paweł Brzegowy ◽  
Agnieszka Słowik ◽  
Paweł Latacz ◽  
Roman Pułyk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Patients

scholarly journals Venous return in acute ischaemic stroke patients measured during computed tomography angiography of head and neck

2021 ◽  
Author(s):  
Bartłomiej Łasocha ◽  
Anna M. Grochowska ◽  
Paweł Wrona ◽  
Paweł J. Brzegowy ◽  
Roman Pułyk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischaemic Stroke ◽  
Head And Neck ◽  
Acute Ischaemic Stroke ◽  
Computed Tomography Angiography ◽  
Venous Return ◽  
Stroke Patients

Association of Admission NIHSS Score with Infarct Core Volume and Target Mismatch of Infarct Core/Penumbra Volume on CT Perfusion in Acute Ischaemic Stroke

2021 ◽  
pp. 1-7
Author(s):  
Wenjie Cao ◽  
Yifeng Ling ◽  
Lumeng Yang ◽  
Fei Wu ◽  
Hui Zhang ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Ct Perfusion ◽  
Area Under The Curve ◽  
Neurological Impairment ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Infarct Core ◽  
The Gaze ◽  
Core Volume

<b><i>Introduction:</i></b> Neurological impairment is associated with collateral status in acute ischaemic stroke (AIS). We aimed to validate the association between admission National Institutes of Health Stroke Scale (aNIHSS) score and infarct core volume (ICV) and target infarct core/penumbra volume mismatch (TMM) on CT perfusion (CTP) in AIS patients. <b><i>Methods:</i></b> Patients with acute middle cerebral artery or internal carotid artery occlusion from 2011 to 2020 were included. All patients underwent pretreatment CTP at admission. ICV and TMM were analyzed with MIStar software on CTP maps. aNIHSS scores and clinical characteristics of patients were obtained from our prospectively recorded stroke database. <b><i>Results:</i></b> We recruited 182 patients with a median age of 69.5 years; 85 (63.7%) were male, and the median aNIHSS score was 14. Of those, 149 (81.8%) had an ICV &#x3c; 70 mL, and 139 (76.3%) had TMM. Lower aNIHSS was associated with an ICV &#x3c; 70 mL, with an area under the curve (AUC) of 0.74, and TMM with an AUC of 0.76. Among all 15 items of the aNIHSS, the gaze score was the only item independently associated with an ICV &#x3c; 70 mL (adjusted odds ratio [OR] = 0.42, 95% confidence interval [CI]: 0.22–0.79, <i>p</i> = 0.008) and TMM (adjusted OR = 0.5, 95% CI: 0.28–0.9, <i>p</i> = 0.021). One or both aNIHSS ≤ 16 and gaze score = 0 predicted TMM with a sensitivity of 0.79 and a specificity of 0.62. <b><i>Conclusion:</i></b> aNIHSS may be a useful tool to predict an ICV &#x3c; 70 mL and TMM on CTP in AIS patients.

A physiological perspective of the associations between hydration status and CTP neuroimaging parameters in hyper‐acute ischaemic stroke patients

2021 ◽  
Author(s):  
Alex Buoite Stella ◽  
Miloš Ajčević ◽  
Giovanni Furlanis ◽  
Carlo Lugnan ◽  
Marina Gaio ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Hydration Status ◽  
Stroke Patients

scholarly journals Mechanical thrombectomy in acute ischaemic stroke patients with pre-interventional intracranial haemorrhage following intravenous thrombolysis

2021 ◽  
pp. 197140092110091
Author(s):  
Hanna Styczen ◽  
Matthias Gawlitza ◽  
Nuran Abdullayev ◽  
Alex Brehm ◽  
Carmen Serna-Candel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intracranial Haemorrhage ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion

Background Data on outcome of endovascular treatment in patients with acute ischaemic stroke due to large vessel occlusion suffering from intravenous thrombolysis-associated intracranial haemorrhage prior to mechanical thrombectomy remain scarce. Addressing this subject, we report our multicentre experience. Methods A retrospective analysis of consecutive acute ischaemic stroke patients treated with mechanical thrombectomy due to large vessel occlusion despite the pre-interventional occurrence of intravenous thrombolysis-associated intracranial haemorrhage was performed at five tertiary care centres between January 2010–September 2020. Baseline demographics, aetiology of stroke and intracranial haemorrhage, angiographic outcome assessed by the Thrombolysis in Cerebral Infarction score and clinical outcome evaluated by the modified Rankin Scale at 90 days were recorded. Results In total, six patients were included in the study. Five individuals demonstrated cerebral intraparenchymal haemorrhage on pre-interventional imaging; in one patient additional subdural haematoma was observed and one patient suffered from isolated subarachnoid haemorrhage. All patients except one were treated by the ‘drip-and-ship’ paradigm. Successful reperfusion was achieved in 4/6 (67%) individuals. In 5/6 (83%) patients, the pre-interventional intracranial haemorrhage had aggravated in post-interventional computed tomography with space-occupying effect. Overall, five patients had died during the hospital stay. The clinical outcome of the survivor was modified Rankin Scale=4 at 90 days follow-up. Conclusion Mechanical thrombectomy in patients with intravenous thrombolysis-associated intracranial haemorrhage is technically feasible. The clinical outcome of this subgroup of stroke patients, however, appears to be devastating with high mortality and only carefully selected patients might benefit from endovascular treatment.

Obesity in acute ischaemic stroke patients treated with intravenous thrombolysis therapy

2021 ◽  
pp. 1-8
Author(s):  
Hongmin Li ◽  
Suliman Khan ◽  
Rabeea Siddique ◽  
Qian Bai ◽  
Yang Liu ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Thrombolysis Therapy

Abstract WMP18: CT Work-Up of Patients Suspected of Acute Ischemic Stroke: Perfusion-CT Adds Value Compared to Clinical Evaluation, Noncontrast Head CT and CT-Angiogram in Terms of Predicting Outcome

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Guangming Zhu ◽  
Patrik Michel ◽  
Amin Aghaebrahim ◽  
James T Patrie ◽  
Wenjun Xin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Data ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Perfusion Ct ◽  
Infarct Core ◽  
Head Ct ◽  
Ct Angiogram ◽  
Work Up

BACKGROUND AND PURPOSE: To determine whether Perfusion-CT (PCT) adds value to Noncontrast head CT (NCT), CT-Angiogram (CTA) and clinical assessment in patients suspected of acute ischemic stroke. METHODS: We retrospectively reviewed the clinical and imaging data collected in 165 patients with acute ischemic stroke. ASPECTS score was calculated from NCT. CTA was reviewed for site of occlusion and collateral flow score. PCT was used to calculate the volumes of infarct core and ischemic penumbra on admission. Recanalization status was assessed on follow-up imaging. Clinical data included age, time from onset to baseline imaging, time from baseline imaging to reperfusion therapy, time from baseline imaging to recanalization imaging, NIHSS at baseline, treatment type and modified Rankin score (mRS) at 90 days. In a first multivariate regression analysis, we used volume of PCT penumbra and infarct core as outcome, and assessed whether they could be predicted from clinical variables, NCT and/or CTA. In a second multivariate regression analysis, we used mRS at 90 days as outcome, and determined which imaging and clinical variables predicted it best. RESULTS: 165 patients were identified. Mean±SD time from onset to baseline imaging was 6.7±8.7 hrs. 76 had a good outcome (90-day mRS 0-2), 89 had a poor outcome. Mean±SD PCT infarct was 44.8±46.5 ml. Mean±SD PCT penumbra was 47.0±33.9 ml. PCT infarct could be predicted by clinical data, NCT, CTA, and combinations of this data (P<0.05); the best predictive model included the clinical data, plus NCT and CTA. PCT Penumbra could NOT be predicted by clinical data, NCT, and CTA. In terms of predicting mRS at 90 days, all of variables but NCT and CTA were significantly associated with 90-day mRS outcome. The single most important predictor was recanalization status (P<0.001). PCT penumbra volume (P=0.001) was also a predictor of clinical outcome, especially when considered in conjunction with recanalization through an interaction term (P<0.001). CONCLUSION: PCT penumbra represents independent information, which cannot be predicted by clinical, NCT, and CTA data. PCT penumbra is an important determinant of clinical outcome, and adds relevant clinical information compared to a stroke CT work-up including NCT and CTA.

Abstract 1122‐000034: Systematic CT‐Perfusion acquisition in All Suspected Stroke Patients Increases Vascular Occlusion Detection and Thrombectomy Rates

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Marta Olive‐Gadea ◽  
Manuel Requena ◽  
Facundo Diaz ◽  
Alvaro Garcia‐Tornel ◽  
Marta Rubiera ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Symptoms ◽  
Ct Perfusion ◽  
False Negative ◽  
False Negative Rate ◽  
Vascular Occlusion ◽  
Stroke Patients ◽  
Imaging Protocols ◽  
The Impact

Introduction : In acute ischemic stroke patients, current guidelines recommend noninvasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols on VO diagnosis and EVT rates. Methods : We included patients with a suspected acute ischemic stroke that underwent urgent non‐contrast CT, CTA and CTP from April to October 2020. Hypoperfusion areas defined by Tmax>6s delay (RAPID software), congruent with the clinical symptoms and a vascular territory, were considered due to a VO (CTP‐VO). Cases in which mechanical thrombectomy was performed were defined as therapeutically relevant VO (EVT‐VO). For patients that received EVT, site of VO according to digital subtraction angiography was recorded. Two experienced neuroradiologists blinded to CTP but not to clinical symptoms, retrospectively evaluated NCCT and CTA to identify intracranial VO (CTA‐VO). We analyzed CTA‐VO sensitivity and specificity at detecting CTP‐VO and EVT‐VO respecitvely. We performed a logistic regression to test the association of Tmax>6s volumes with CTA‐VO identification and indication of EVT. Results : Of the 338 patients included in the analysis, 157 (46.5%) presented a CTP‐VO, (median Tmax>6s: 73 [29‐127] ml). CTA‐VO was identified in 83 (24.5%) of the cases. Overall CTA‐VO sensitivity for the detection of CTP‐VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with an increased CTA‐VO detection, with an odds ratio of 1.03 (95% confidence interval 1.02‐1.04) (figure). DSA was indicated in 107 patients; in 4 of them no EVT was attempted due to recanalization or a too distal VO in the first angiographic run. EVT was performed in 103 patients (30.5%. Tmax>6s: 102 [63‐160] ml), representing 65.6% of all CTP‐VO. Overall CTA‐VO sensitivity for the detection of EVT‐VO was 69.9%. The CTA‐VO sensitivity for detecting patients with indication of EVT according to clinical guidelines was as follows: 91.7% for ICA occlusions and 84.4% for M1‐MCA occlusions. For all other occlusion sites that received EVT, the CTA‐VO sensitivity was 36.1%. The overall specificity was 95.3%. Among patients who received EVT, CTA‐VO was not detected in 31 cases, resulting in a false negative rate of 30.1%. False negative CTA‐VO cases had lower Tmax>6s volumes (69[46‐99.5] vs 126[84‐169.5]ml, p<0.001) and lower NIHSS (13[8.5‐16] vs 17[14‐21], p<0.001). Conclusions : Systematically including CTP perfusion in the acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.

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