Some day there are going to be dozens on researchers working on that and they'll wonder why they took so long to understand the etiology of stroke damage.
http://stroke.ahajournals.org/content/45/9/2683.abstract?etoc
- Cheemun Lum, MD, FRCP;
- Muhammad Ejaz Ahmed, MBBS;
- Satya Patro, MBBS;
- Rebecca Thornhill, PhD;
- Matthew Hogan, MD, FRCP;
- Daniela Iancu, MD;
- Howard Lesiuk, MD, FRCS;
- Marlise dos Santos, MD, MSc;
- Dar Dowlatshahi, MD, PhD, FRCPC;
- on behalf of the Ottawa Stroke Research Group (OSRG)
+ Author Affiliations
- Correspondence to Cheemun Lum, MD, C1-Diagnostic Imaging, Civic Campus, The Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9. E-mail chlum@ottawahospital.on.ca
Abstract
Background and Purpose—Recanalization
rates are higher in acute anterior stroke treated with stent-retrievers
when compared with older techniques.
However, some still have sizeable infarcts
and poor outcome. This may be related to underestimation of core infarct
on nonenhanced
computed tomography (NECT). CT angiography
(CTA) source images (CTASI) and CT perfusion may be more informative. We
hypothesize
that core infarct estimation with NECT, CTA,
and CT perfusion predicts infarct at 24 hours and outcome after fast
recanalization.
Methods—Consecutive
good recanalization patients with proximal anterior circulation stroke
were evaluated. We assessed Alberta Stroke
Program Early CT Score (ASPECTs) on NECT for
subtle early infarct, hypodensity, loss of gray–white (CTASI), and low
cerebral
blood volume (CBV; CT perfusion). Sensitivity
and specificity for predicting infarct by region were calculated.
Results—Of 46
patients, 36 (78%) had successful thrombectomy. Median ASPECTS was 10
for NECT early infarct and frank hypodensity;
for CBV, CTASI-ASPECTS was 8. CTASI had the
highest sensitivity of 71% and specificity of 82% for 24 hours NECT
infarct. There
was moderate correlation and concordance
between CBV/24-hour NECT (Rp=0.51; Rc=0.50) and CTASI/24-hour NECT (Rp=0.54 and Rc=0.53). Thirty-four patients (74%) had good outcomes. Median ASPECTS was higher on CTASI (8 versus 5; P=0.04) and CBV (9 versus 5; P=0.03) for patients with good versus bad outcome. There were better outcomes with increasing CTASI-ASPECTS (P=0.004) and CBV-ASPECTS (P=0.02).
Conclusions—CTASI and CBV were better at predicting 24-hour infarct and outcome than NECT. Appropriate advanced imaged guided selection
may improve outcomes in large-vessel stroke treated with the newest techniques.
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